迷走神经刺激术治疗风湿免疫疾病的研究进展

Advances in vagal nerve stimulation for the treatment of rheumatic disease

风湿免疫疾病是导致关节疼痛、功能障碍的重要原因,严重影响患者身体健康及生活质量。目前认为其发病机制与自主神经,尤其是迷走神经介导的免疫炎症反应关系密切。迷走神经刺激术(vagus nerve stimulation,VNS)是众所周知的激活神经调节系统的有效且安全的方法,2011年开始被用于治疗风湿免疫疾病中的纤维肌痛综合征,后又用于辅助治疗类风湿关节炎、系统性红斑狼疮及风湿性多肌痛。根据在Pubmed中检索到的VNS治疗风湿免疫疾病相关的所有文献,我们观察到,VNS能够将甲氨蝶呤治疗失败的类风湿关节炎患者美国风湿病学院病情改善20%达标率提高至70.0%~71.4%;在纤维肌痛综合征患者疼痛缓解率为58.34%~100%;在系统性红斑狼疮及风湿性多肌痛患者中也能够明显缓解关节疼痛、疲乏等不适。在安全性方面,所有文献中仅有1例患者出现颈部疼痛无法耐受植入型VNS,其余均未报道严重不良反应,常见的不良反应有变声、伤口感染、局部疼痛等。目前的研究结果提示VNS在风湿免疫疾病的治疗中是较新的尝试,同时表明VNS在风湿免疫疾病治疗中具有良好的应用前景和独特的优势。

Rheumatic disease is a common cause of joint pain and dysfunction,which seriously affects the health and living quality of patients.At present,the pathogenesis of rheumatic disease is mainly related to the immune inflammatory response,which mediated by the autonomic nerves,especially the vagus nerve.Vagus nerve stimulation(VNS)is known to be effective and safe method to activate nervous system.It was first used to treat fibromyalgia syndrome in 2011,and later used as an adjuvant treatment for rheumatoid arthritis,systemic lupus erythematosus and polymyalgia rheumatica.By searching literatures about VNS for rheumatic disease in Pubmed,we found that VNS could improve the ACR20 compliance rate to 70.0%~71.4% in the patients with rheumatoid arthritis who failed to methotrexate.The pain relief rates were 58.34%~100% in patients with fibromyalgia syndrome.Meanwhile,it could significantly relieve joint pain,fatigue and other symptoms in patients with systemic lupus erythematosus and polymyalgia rheumatica.No severe side effects were reported and only one patient suffered from neck pain and could not tolerate implanted VNS.The common adverse events include voice change,wound infection,local pain,etc.VNS is relatively new in the treatment of rheumatic diseases with promising applications and unique advantages.