基于静息态fMRI技术观察耳甲电针治疗首发性抑郁症即刻脑效应

Immediate brain effects of electroacupuncture at auricular concha in the treatment of first-episode depression using the resting-state fMRI technology

目的观察耳甲电针即经皮迷走神经刺激(transcutaneous auricular vagus nerve stimulation,taVNS)对首发性抑郁症(first-episode depression,FED)静息态功能磁共振(resting-state functional magnetic resonance imaging,rs-fMRI)脑功能活动的即刻调节作用。方法将29例FED患者作为FED组,29例健康者作为健康组。FED组采用taVNS治疗,并于治疗前后即刻行fMRI扫描;健康组不予治疗仅纳入时行fMRI扫描。将基线期两组比较和FED组自身治疗前后比较所诱导的ALFF重合差异脑区作为种子点,分析FED组治疗前后的全脑功能连接(functional connectivity,FC)变化。结果与健康组比较,FED组治疗前ALFF在左侧额中回、右侧额中回、左侧眶部额下回及右侧颞中回升高(t=5.24,4.64,4.93,4.71;P<0.005),在左侧楔前叶、右侧楔前叶、左侧矩状回、右侧矩状回及左侧壳核减低(t=﹣3.79,﹣5.62,﹣3.50,﹣3.51,﹣3.49;P<0.005)。与治疗前比较,FED组治疗后左侧额中回、左侧补充运动区ALFF降低(t=﹣2.76,﹣2.77;P<0.005)。以左侧额中回为感兴趣区进行治疗前后全脑FC比较,FED组治疗后在右侧楔前叶、左侧矩状回、右侧枕上回和右侧中央沟盖回的FC增强(t=3.61,3.72,4.98,5.00;P<0.005),在左侧额中回、左侧眶部额下回的FC降低(t=﹣3.06,﹣3.18;P<0.005)。结论FED患者存在认知控制网络、默认网络及奖赏网络等脑区功能活动异常。耳甲电针具有即刻调制FED患者认知控制网络、默认网络、奖赏网络及视觉加工网络部分脑区功能活动的作用,这可能是其治疗FED潜在的脑效应机制。

Objective To observe the immediate regulation effects of auricular concha electroacupuncture(transcutaneous auricular vagus nerve stimulation,taVNS)on brain activities in first-episode depression(FED)using resting-state functional magnetic resonance imaging(rs-fMRI).Method Twenty-nine FED patients were recruited as the FED group,and 29 healthy people were taken as the healthy group.The FED group was treated with taVNS and examined using functional magnetic resonance imaging(fMRI);the healthy group only received an fMRI examination at the recruitment without any intervention.The overlapped differential brain areas of the amplitude of low-frequency fluctuation(ALFF),indicated by the between-group comparison at the baseline and the intra-group comparison of the FED group before and after the treatment,were taken as the seed points to analyze the change in the whole brain functional connectivity(FC)in the FED group.Result Compared with the healthy group before the treatment,the FED group showed increased ALFF in the left middle frontal gyrus,right middle frontal gyrus,left orbital inferior frontal gyrus,and right middle temporal gyrus(t=5.24,4.64,4.93,4.71;P<0.005)and decreased ALFF in the left precuneus,right precuneus,left calcarine gyrus,right calcarine gyrus,and left putamen(t=﹣3.79,﹣5.62,﹣3.50,﹣3.51,﹣3.49;P<0.005).After the treatment,the ALFF dropped in the left middle frontal gyrus and left supplementary motor area(t=﹣2.76,﹣2.77;P<0.005)in the FED group.With the left middle frontal gyrus as the region of interest(ROI)to compare the whole brain FC,the FED group showed strengthened FC in the right precuneus,left calcarine gyrus,right superior occipital gyrus,and right Rolandic operculum(t=3.61,3.72,4.98,5.00;P<0.005)and weakened FC in the left middle frontal gyrus and left orbital inferior frontal gyrus(t=﹣3.06,﹣3.18;P<0.005).Conclusion Patients with FED have abnormal functional activities in brain areas such as the cognitive control network,default network,and reward network.The taVNS can play a role in the instant modulation of functional activities of some brain areas in the cognitive control network,default network,reward network,and visual processing network in FED patients,which may be a potential brain effect mechanism in treating FED.