基于静息态功能磁共振成像观察耳电针对难治性抑郁症的即刻脑效应  

Instant brain effect of transcutaneous auricular vagus nerve stimulation in treating the treatment-resistant depression by resting rtate functional magnetic resonance imaging

作　　者：王智 何家恺 孙继飞 陈丽梅 郭春蕾 张国雷 方继良[1] WANG Zhi;HE Jiakai;SUN Jifei;CHEN Limei;GUO Chunlei;ZHANG Guolei;FANG Jiliang(Functional Brain imaging Lab,Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China;Institute of Acupuncture and Moxibustion,China Academy of Chinese Medical Sciences,Beijing 100700,China;Department of Radiology,Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China)

机构地区：[1]中国中医科学院广安门医院功能成像室,北京100053 [2]中国中医科学院针灸研究所,北京100700 [3]中国中医科学院广安门医院放射科,北京100053

出　　处：《磁共振成像》2022年第1期70-75,97,共7页Chinese Journal of Magnetic Resonance Imaging

基　　金：国家重点研发项目(编号:2018YFC1705802);国家自然科学基金面上项目(编号:81774433);中国中医科学院2019年中医药“一带一路”国际合作专项课题(编号:GH201912)。

摘　　要：目的采用静息态功能磁共振成像(resting-state functional magnetic resonance imaging,rs-fMRI)技术,探讨耳电针,即经皮耳穴迷走神经刺激(transcutaneous auricular vagus nerve stimulation,taVNS)治疗难治性抑郁症(treatment-resistant depression,TRD)的即刻脑效应。材料与方法纳入34例TRD和34例健康对照(health controls,HC),评估每位受试者相关临床量表,随后对TRD进行30 min taVNS即刻刺激治疗,采集相关rs-fMRI数据。比较患者与健康对照的低频振幅(amplitude of low-frequency fluctuation,ALFF)值,以及刺激前后的ALFF值变化;再与临床量表评分进行偏相关分析;再将差异脑区作为种子点,计算其与全脑的功能连接(functional connectivity,FC)。结果刺激前,TRD组在左侧苍白球/下丘脑/尾状核、左侧中央前回/额中回的ALFF值较高;左侧中央前回/额中回分别与双侧扣带回、双侧辅助运动区、左侧内侧额上回、左侧豆状核(包括苍白球和壳核)的FC较高;左侧中央前回/额中回ALFF值分别与HAMD-17(P=0.013,r=0.442)、SDS(P=0.026,r=0.400)评分成正相关。TRD治疗后在左侧额下中回眶部、双侧小脑1区、左侧小脑2区的ALFF值显著升高。结论TRD患者存在边缘系统-皮层-纹状体-苍白球-丘脑神经环路脑功能活动异常,其中认知及运动皮层相关脑区脑功能异常可能与负性情绪有关;taVNS可即刻调节TRD患者的脑自发活动,涉及情感认知相关脑区,可能是耳甲电针治疗TRD的脑功能潜在靶点脑区。Objective:Resting state functional magnetic resonance imaging(rs-fMRI)was used to investigate the instant brain effect of transcutaneous auricular vagus nerve stimulation(taVNS)on treatment-resistant depression(TRD),in order to lay a foundation for revealing the brain mechanism of taVNS's therapeutic effect.Materials and Methods:Thirty-four TRD and 34 healthy volunteers were enrolled,and the data of scale's scores were recorded for every subject.TRD were stimulated by taVNS for 30 minutes,and the rs-fMRI data were collected twice before and after stimulation immediately.Healthy volunteers were not stimulated and only scanned once with rs-fMRI.After comparing the amplitude of low frequency fluctuation(ALFF),functional connectivity(FC)values between TRD and HC,the ALFF values of different brain regions were further extracted and analyzed for partial correlation with scale's scores.Results:In baseline,the ALFF values in the left pallidus/hypothalamus/caudate,the left precentral/middle frontal gyrus in the TRD group were significantly higher.ALFF values of left precentral/middle frontal gyrus were positively correlated with HAMD-17,SDS scores of TRD patients,respectively[(P=0.013,r=0.442),(P=0.026,r=0.400)].It found that the FC value between left precentral gyrus/middle frontal gyrus and bilateral middle cingulate gyrus,support motor areas,left medial superior frontal gyrus and left lenticulate nucleus(including pallidus and putamen)was significantly higher.In TRD,the ALFF values of pre-treatment were significantly lower than that in post-treatment in the bilateral cerebellar area 1 and left cerebellar area 2 in the left inferior middle frontal gyrus orbital region.Conclusions:TRD showed the abnormal brain functional activities in limbic system-cortical-striatus-globus-pallidus-thalamus neural circuit,in which motor cortex and cognition-related brain regions may be related to the negative emotion.TaVNS can immediately regulate brain spontaneous activities in TRD patients,which involves brain regions related to emotio

关 键 词：静息态功能磁共振成像 难治性抑郁症 经皮耳穴迷走神经刺激 即刻效应 额叶眶部 

分 类 号：R445.2[医药卫生—影像医学与核医学] R749.4[医药卫生—诊断学]