针刺联合经皮耳廓迷走神经刺激对轻度抑郁症的炎症因子和神经重塑的影响

Effects of acupuncture combined with percutaneous auricular vagus nerve stimulation on inflammatory factors and neural remodeling in patients with mild depression

目的探究针刺联合经皮耳廓迷走神经刺激(tVNS)对轻度抑郁症的炎症因子和神经重塑的影响。方法选取80例轻度抑郁症患者为研究对象,随机分为针刺组和对照组各40例。针刺组采用针刺+经皮耳廓迷走神经刺激治疗,对照组给予安慰针刺治疗。采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、焦虑自评量表(SAS)和抑郁自评量表(SDS)比较治疗后患者的抑郁焦虑程度。通过ELISA分析检测患者血清炎症因子水平。通过经皮耳迷走神经刺激和脑电图来评估患者前额叶和运动皮层的神经可塑性。通过高压液相色谱-电化学检测神经递质水平。采用简明幸福与生活质量满意度问卷(Q-LES-Q-SF)调查对生活质量作出评估。结果针刺组HAMD、HAMA、SAS和SDS评分均低于对照组(P<0.05)。针刺组TNF-α、1L-1α、1L-6和1L-2水平均低于对照组(P<0.05)。针刺组前额叶皮层诱发活动较对照组增强(P<0.05),针刺组前额叶皮层抑制、运动皮层诱发、运动皮层抑制均较对照组减弱(P<0.05)。针刺组5-HT、DA和NE水平高于对照组(P<0.05),针刺组OFQ水平低于对照组(P<0.05)。针刺组生理领域、心理领域、社会关系领域和环境领域评分均高于对照组(P<0.05)。结论tVNS通过神经元、免疫介导和神经内分泌介导的信号通路降低轻度抑郁症患者的炎症水平,并通过增强样机制在额叶皮层产生神经可塑性,减轻抑郁症状。

Objective To explore the effects of acupuncture combined with percutaneous auricular vagus nerve stimulation(tVNS)on inflammatory factors and nerve remodeling in patients with mild depression.Methods 80 patients with mild depression were selected and randomly divided into acupuncture group(n=40)treated with acupuncture+percutaneous auricular vagus nerve stimulation and control group(n=40)treated with consolation acupuncture.All the subjects were assessed with Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA),Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS)and Quality of Life Enjoyment and Satisfaction Questionnaire,Short Form(Q-LES-Q-SF)after treatment.Serum levels of inflammatory factors were detected by ELISA.Neuroplasticity levels in the prefrontal and motor cortexes were assessed by percutaneous auricular vagus nerve stimulation and electroencephalography.The levels of neurotransmitters were detected by high pressure liquid chromatography-electrochemistry.Results The total scores of HAMD,HAMA,SAS and SDS in acupuncture group were significantly lower than those in control group(P<0.05).The levels of TNF-α,1L-1α,1L-6 and 1L-2 in acupuncture group were significantly lower than those in control group(P<0.05).Acupuncture group showed enhanced prefrontal cortex induction,weakened prefrontal cortex inhibition,weakened motor cortex induction and weakened motor cortex inhibition than control group(P<0.05).In acupuncture group,the levels of 5-HT,DA and NE were significantly higher and the level of OFQ was significantly lower than those in control group(P<0.05).The scores of physiological field,psychological field,social relationship field and environmental field of Q-LES-Q-SF in acupuncture group were all higher than those in control group(P<0.05).Conclusion tVNS reduces the level of inflammation in patients with mild depression through neuronal,immune-mediated and neuroendocrine-mediated signaling pathways,and induces neuroplasticity in the frontal cortex through a potentiation-like mechanism to alleviate depressive symptoms.