基于局部一致性分析经皮耳迷走神经刺激治疗原发性失眠的中枢效应机制

Central mechanism study of transcutaneous auricular vagus nerve stimulation based on ReHo in the treatment of primary insomnia

目的:探讨经皮耳迷走神经刺激(taVNS)治疗原发性失眠(PI)的中枢效应机制。方法:纳入PI患者15例,采用治疗前后自身对照的原则,予以taVNS治疗4周,利用静息态功能磁共振技术,采集治疗前后患者的脑核磁数据,通过局部一致性(ReHo)的分析方法,观察taVNS对患者脑区局部一致性的调节作用。结果:PI患者经过taVNS治疗4周后,大脑多个脑区发生局部一致性的改变,其中左侧内侧额上回(t=5.36,P<0.01)、右侧前扣带回(t=5.36,P<0.01)ReHo值升高,而右侧颞下回(t=-5.19,P<0.01)、双侧颞中回(t=-5.09,P<0.01)、右侧丘脑(t=-4.88,P<0.01)ReHo值降低。结论:taVNS对前额叶、前扣带回、颞叶、丘脑等相关区域功能的调节可能是其治疗PI的中枢效应机制。

Objective: To investigate the central mechanism of transcutaneous auricular vagus nerve stimulation(taVNS) in the treatment of primary insomnia(PI). Methods: Fifteen patients with PI were enrolled in the study. PI subjects were treated with taVNS for 4 weeks according to the principle of self-control before and after treatment. The brain MRI data of patients before and after treatment were collected by resting-state functional MRI scanning. And the regulatory effect of taVNS on local consistency of patients’ brain was observed by ReHo analysis method. Results: After four weeks taVNS treatment, PI patients had functional consistency changes in multiple brain regions. The regional homogeneity(ReHo) value of left medial superior frontal gyrus(t=5.36, P<0.01) and right anterior cingulate gyrus(t=5.36, P<0.01) increased, while the ReHo value of right inferior temporal gyrus(t=-5.19, P<0.01), bilateral sacral gyrus(t=-5.09, P<0.01), and right thalamus(t=-4.88, P<0.01) decreased. Conclusion: The regulation of taVNS on the functions of prefrontal lobes, anterior cingulate gyrus, temporal lobe and thalamus may be the central mechanism of taVNS in the treatment of PI.