方继良815上海会议.pdf

2015年针灸影像培训班 电针耳迷走神经治疗抑郁症 临床及脑机理fMRI研究 方继良 中国中医科学院广安门医院 放射科功能成像研究室 2015.08.15 上海 研究背景 1）2005美国FDA批准手术埋置颈部深部的迷走神经刺 激仪治疗难治性抑郁症 。 手术埋置颈部迷走神经刺激仪 治疗难治性抑郁症 有效 • Background To better understand these effects on long-term outcome, we compared 12- month VNS+TAU outcomes with those of a comparable TRD group. Methods Admission criteria were similar for those receiving VNS+TAU (n = 205) or only TAU (n = 124). Both groups received similar TAU (drugs and electroconvulsive therapy) during follow-up. Results Vagus nerve stimulation plus treatment as usual was associated with greater improvement per month in IDS-SR30 than TAU across 12 months (p .001). Response rates according to the 24-item Hamilton Rating Scale for Depression (last observation carried forward) at 12 months were 27% for VNS+TAU and 13% for TAU (p .011). Conclusions This comparison of two similar but nonrandomized TRD groups showed that VNS+TAU was associated with a greater antidepressant benefit over 12 months. • George MS, et al. Biological Psychiatry 2005 临床疗效分析 1. VNS治疗抑郁症研究 Meta分析，在687个研究中，应答率在治疗2年时最高可达 42%，症状缓解率为22%，VNS 已经显示了对抑郁症的临 床效果。 Martin et al 2012 European Psychiatry 2. tVNS(经皮迷走神经刺激）治疗抑郁症研究 2013年Hein E （Kraus T研究组）录入37例进行随机对照试 验，治疗14天后，tVNS组贝克自评量表积分明显减低，但 HAMD积分未见显著性差异。 Hein E et al 2013 J Neural Transmission 针灸耳穴－迷走神经联系研究 • 解剖基础：耳甲区 －－ 唯一体表分布有迷走神经 • 耳部内脏穴位区 耳穴迷走神经分布区 • 中国中医科学院针灸所研制了耳迷走神经电刺激仪， 已用于治疗癫痫病及抑郁症, 初步发现有一定的疗效。 耳部神经分布图 耳部内脏穴位区 耳穴迷走神经分布区