【摘要】 目的：观察经皮耳迷走神经刺激（taVNS）治疗帕金森病抑郁（DPD）的临床疗效并基于静息态fMRI探讨其作用机制。方法：招募20例DPD患者予以taVNS干预（30 min/次，6次/周，共治疗4周）。采用汉密尔顿抑郁量表（HAMD）、统一帕金森病量表（UPDRS）、非运动症状量表（NMSS）、帕金森生活质量量表（PDQ）评价taVNS治疗DPD的临床疗效。20例在治疗前后分别行静息态fMRI扫描，以双侧后扣带回作为种子点，计算后扣带回与全脑之间的功能连接（FC）值。提取DPD患者治疗前后差异脑区的FC值，并与临床量表评分行相关性分析。结果：与治疗前相比，治疗后DPD患者HAMD、UPDRS、NMSS、PDQ评分均显著下降（均P<0.05）。治疗后DPD患者左侧后扣带回与右侧额中回、右侧顶下小叶的FC值降低，左侧后扣带回与右侧枕下回的FC值升高；右侧后扣带回与右侧额中回的FC值降低（均P<0.005,GRF校正）。治疗前后左侧后扣带回与右侧额中回的FC差值与HAMD评分呈正相关（r=0.457,P=0.043，未校正）。结论：taVNS可能通过调节后扣带回与其他脑区的FC，进而改善患者的抑郁症状，为DPD的非药物治疗决策提供神经影像学证据。更多还原

【Abstract】 Objective:To explore the efficacy and mechanism of transcutaneous auricular vagus nerve stimulation(taVNS) in treating depression in Parkinson disease(DPD) based on resting-state fMRI. Methods:A total of 20 DPD patients were recruited to receive taVNS intervention(30 minutes per time,6 times per week for 4 weeks). The HAMD,UPDRS,NMSS and PDQ were used to evaluate the clinical efficacy of taVNS for DPD. 20 DPD patients underwent resting-state fMRI scan before and after treatment,and the posterior cingulate cortex was used as the seed point,and the functional connectivity(FC) was calculated between the posterior cingulate cortex and the whole brain. The correlations between FC values of different brain regions and the scale scores in DPD patients were analyzed both before and after treatment. Results:Compared to before treatment,the HAMD,UPDRS,NMSS and PDQ scores of DPD patients were significantly lower after treatment(all P<0.05).After treatment,the FC values of left posterior cingulate cortex with right middle frontal gyrus and right inferior parietal lobule decreased,the FC value between left posterior cingulate cortex and right inferior occipital gyrus increased,and that between right posterior cingulate cortex and right middle frontal gyrus decreased in DPD patients(all P<0.005,GRF corrected). The FC difference before and after treatment between left posterior cingulate cortex and right middle frontal gyrus was positively correlated with the HAMD score(r=0.457,P=0.043,uncorrected). Conclusions:TaVNS can modulate the FC value between the bilateral posterior cingulate cortex and other brain regions,and is associated with the improvement of depressive symptoms in DPD patients,and can provide neuroimaging evidence for non-drug treatment decisions for DPD.更多还原