迷走神经刺激术治疗难治性抑郁症的临床研究

Clinical research of vagus nerve stimulation for treatment-resistant depression

目的探讨迷走神经刺激术(vagus nerve stimulation,VNS)辅助治疗难治性抑郁症(treatment-resistant depression,TRD)的临床疗效。方法对7例TRD病人在常规抗抑郁治疗的基础上辅助VNS治疗,分别在术前、开机后3个月和开机后9个月行24项汉密尔顿抑郁量表(Hamilton depression scale-24,HAMD-24)、功能大体评定量表(global assessment function,GAF)评分、血清脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)检测及静息态功能磁共振扫描,用比率低频振幅(fractional amplitude of low-frequency fluctuations,fALFF)评估脑功能变化。结果与术前比较,TRD病人开机后3个月和开机后9个月HAMD-24评分呈持续性降低(P <0.05),GAF评分逐渐增高(P <0.05),开机后9个月血清BDNF明显升高(P <0.05),右侧小脑后叶、右侧前扣带回fALFF值降低(P <0.05),右侧中央前后回fALFF值增高(P <0.05)。结论在常规治疗的基础上联和应用VNS,能显著改善TRD病人的抑郁情绪,提高其社交、职业及学习功能,提高其血清BDNF含量,显著改善TRD病人的脑功能。

Objective To explore the clinical efficacy of vagus nerve stimulation(VNS)as adjuvant therapy for treatment-resistant depression(TRD).Methods Seven patients with TRD were treated with VNS on the basis of conventional therapy.The Hamilton depression scale-24(HAMD-24),global assessment of function(GAF),brain-derived neurotrophic factor(BDNF)and rest-state functional magnetic resonance(rs-fMRI)scanning were conducted preoperation,3 and 9 months after power on,and fractional amplitude of low-frequency fluctuations(fALFFs)was used for evaluating the brain functional changes.Results Compared with the preoperation,the HAMD-24 scores were continuously decreased(P<0.05),the GAF scores gradually increased during 3 and 9 months after power on(P<0.05),the concentration of serum BDNF increased significantly 9 months after power on(P<0.05),the fALFF decreased in right posterior cerebellar lobe and right anterior cingulate cortex and increased in right pre/post-central gyri 9 months after power on(P<0.05).Conclusion Adjuvant therapy of VNS base on conventional treatment can significantly improve depressive symptoms,recover the function of social communication,work and study,increase serum BDNF level and improve brain function in TRD patients.