耳迷走神经刺激联合阿戈美拉汀治疗难治性抑郁症的疗效及作用机制研究

Study on efficacy and role mechanism of auricular vagus nerve stimulation combined with agomelatine in the treatment of treatment-resistant depression

目的:探讨经皮迷走神经刺激(tVNS)联合阿戈美拉汀治疗难治性抑郁症(TRD)的临床疗效及机制。方法:选取100例TRD患者为研究对象,依据治疗方式不同分为对照组与观察组,每组各50例。对照组予以阿戈美拉汀治疗;观察组予以tVNS联合阿戈美拉汀治疗,疗程均为8周。比较两组患者治疗总有效率、汉密尔顿抑郁量表(HAMD)、比兹堡睡眠质量指数(PSQI)评分及血清5-羟色胺(5-HT)、去甲肾上腺素(NE)、脑源性神经营养因子(BDNF)水平和不良反应发生情况。结果:观察组患者治疗总有效率高于对照组(P<0.05)。治疗2周、4周、8周后,观察组HAMD及PSQI评分均低于对照组(P<0.05)。治疗8周后,观察组血清5-HT、NE、BDNF水平均高于对照组(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论:tVNS联合阿戈美拉汀治疗TRD能够更好更迅速改善患者抑郁症状及睡眠状况,且安全性好,其机制可能与上调血清5-HT、NE、BDNF水平有关。

Objective:To investigate the clinical efficacy and role mechanism of transcutaneous vagus nerve stimulation(tVNS)combined with agomelatine in the treatment of treatment-resistant depression(TRD).Methods:A total of 100 patients with TRD were divided into the control group(n=50)and the observation group(n=50)according to different treatment methods.The control group received agomelatine treatment,whereas the observation group was treated with tVNS combined with agomelatine,and both groups were treated for 8 weeks.The total effective rate of treatment,scores of Hamilton Depression Scale(HAMD)and Bittsburgh Sleep Quality Index(PSQI)and levels of serum 5-hydroxytryptamine(5-HT),norepinephrine(NE)and brain-derived neurotrophic factor(BDNF)were compared between the two groups,and the adverse reactions were observed.Results:The effective rate of the observation group was higher than that of the control group(P<0.05).After 2,4 and 8 weeks of treatment,the HAMD score and PSQI score of the observation group were lower than those of the control group(P<0.05).After 8 weeks of treatment,the levels of serum 5-HT,NE and BDNF in the observation group were significantly higher than those in the control group(P<0.05).There was no significant difference in the incidence rate of adverse reactions between the two groups(P>0.05).Conclusion:tVNS combined with agomelatine can better and rapidly improve the depressive symptoms and sleep status with good safety,the mechanism may be related to the up regulation of serum 5-HT,NE and BDNF levels.