| 李进,孙金铂,吴迪,武文珺,孙润珠,薛姗姗,崔亚朋,王化宁,陈怡环.艾司西酞普兰联合经皮颈部迷走神经刺激对重性抑郁障碍患者的疗效及其对血浆IL-6和IL-10水平的影响[J].四川精神卫生杂志,2025,38(1):7-13.Li Jin,Sun Jinbo,Wu Di,Wu Wenjun,Sun Runzhu,Xue Shanshan,Cui Yapeng,Wang Huaning,Chen Yihuan,Clinical efficacy of escitalopram combined with transcutaneous cervical vagus nerve stimulation therapy for patients with major depressive disorder and its effect on plasma IL-6 and IL-10 levels[J].SICHUAN MENTAL HEALTH,2025,38(1):7-13 |
| 艾司西酞普兰联合经皮颈部迷走神经刺激对重性抑郁障碍患者的疗效及其对血浆IL-6和IL-10水平的影响 |
| Clinical efficacy of escitalopram combined with transcutaneous cervical vagus nerve stimulation therapy for patients with major depressive disorder and its effect on plasma IL-6 and IL-10 levels |
| 投稿时间：2024-06-05 |
| DOI：10.11886/scjsws20240605002 |
| 中文关键词: 经皮颈部迷走神经刺激 重性抑郁障碍 焦虑症状 睡眠质量 炎性因子 |
| 英文关键词:Transcutaneous cervical vagus nerve stimulation Major depressive disorder Anxiety symptoms Sleep quality Inflammatory factors |
| 基金项目:陕西省重点研发计划一般项目（项目名称：迷走神经精准纳米磁刺激治疗焦虑障碍的新策略研究，项目编号：2023-YBSF-185） |
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| 中文摘要: |
| 背景 侵入性迷走神经电刺激被批准用于难治性抑郁症的治疗，其发挥疗效可能与迷走神经刺激（VNS）具有抗炎作用有关。无创的经皮颈部VNS（tcVNS）治疗重性抑郁障碍（MDD）的效果及其对血浆炎性因子水平的影响尚不明确。目的 观察艾司西酞普兰联合tcVNS对MDD患者抑郁、焦虑和睡眠质量的改善情况及其对血浆白细胞介素6（IL-6）和白细胞介素10（IL-10）水平的影响，以期为MDD患者的康复治疗提供参考。方法 选取2019年8月21日—2024年4月17日在空军军医大学第一附属医院心身科门诊就诊、符合《精神障碍诊断与统计手册（第5版）》中MDD诊断标准的45例患者为研究对象。采用随机数字表法分为研究组（n=23）和对照组（n=22）。两组均接受艾司西酞普兰治疗，研究组在此基础上接受为期4周、每天1次、每次30 min的tcVNS治疗，对照组接受相应的tcVNS对照刺激治疗，即在刺激30 s后停止刺激。于治疗前和治疗4周后，使用汉密尔顿抑郁量表17项版（HAMD-17）评定抑郁症状，以HAMD-17中的焦虑/躯体化因子和睡眠障碍因子分别评定患者的焦虑/躯体化症状和睡眠质量。采用酶联免疫吸附测定法检测血浆白细胞介素-6（IL-6）和白细胞介素-10（IL-10）水平。结果 广义估计方程结果显示，两组HAMD-17总评分、焦虑/躯体化因子及睡眠障碍因子评分的时间效应均有统计学意义（Wald χ2=315.226、495.481、82.420，P均<0.01）。治疗4周后，研究组HAMD-17总评分及焦虑/躯体化因子评分均低于对照组，差异均有统计学意义（Wald χ2=4.967、32.543，P<0.05或0.01）；两组睡眠障碍因子评分比较，差异无统计学意义（Wald χ2=0.819，P=0.366）。两组血浆IL-6和IL-10水平的时间效应均有统计学意义（Wald χ2=21.792、5.242，P<0.05或0.01）。治疗4周后，两组血浆IL-6水平均低于治疗前，差异均有统计学意义（Wald χ2=22.015、6.803，P均<0.01）；研究组血浆IL-10水平高于治疗前，差异有统计学意义（Wald χ2=5.118，P=0.024）。结论 艾司西酞普兰联合tcVNS可能有助于改善MDD患者的抑郁症状、焦虑/躯体化症状及睡眠质量，并有助于降低血浆IL-6水平、提高IL-10水平。 |
| 英文摘要: |
| Background Invasive vagus nerve stimulation therapy has been approved for the adjunctive treatment of treatment-resistant depression， which may contribute to the anti-inflammatory properties of vagus nerve stimulation （VNS）， whereas the efficacy of non-invasive transcutaneous cervical vagus nerve stimulation （tcVNS） in treating major depressive disorder （MDD） and its impact on plasma inflammatory factors remain unclear.Objective To observe the effect of escitaloprom combined with tcVNS on the status of depression， anxiety and sleep quality as well as the plasma levels of interleukin-6 （IL-6） and interleukin-10 （IL-10） in MDD patients， in order to provide references for the recovery and treatment of MDD patients.Methods From August 21， 2019 to April 17， 2024， 45 patients who met the diagnostic criteria for MDD in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） were recruited from the psychosomatic outpatient clinic of the First Affiliated Hospital of Air Force Military Medical University. Subjects were divided into study group （n=23） and control group （n=22） using random number table method. All patients were treated with escitalopram. On this basis， study group added a 30-minute tcVNS therapy once a day for 4 weeks. While control group was given corresponding sham stimulation， and the duration of each stimulation lasted 30 seconds. Before and after 4 weeks of treatment， Hamilton Depression Scale-17 item （HAMD-17） was used to assess depressive symptoms， and HAMD-17 anxiety/somatization subfactor and insomnia subfactor were used to assess patients' anxiety/somatization symptoms and sleep quality. Levels of plasma IL-6 and IL-10 were measured by enzyme-linked immunosorbent assay （ELISA）.Results The generalized estimating equation model yielded a significant time effect for HAMD-17 total score， anxiety/somatization subfactor score and insomnia subfactor score in both groups （Wald χ2=315.226， 495.481， 82.420， P<0.01）. After 4 weeks of treatment， HAMD-17 total score and anxiety/somatization subfactor score of study group were lower than those of control group， with statistically significant differences （Wald χ2=4.967， 32.543， P<0.05 or 0.01）， while no statistically significant difference was found in the insomnia subfactor score between two groups （Wald χ2=0.819， P=0.366）. Significant time effects were reported on plasma IL-6 and IL-10 levels in both groups （Wald χ2=21.792， 5.242， P<0.05 or 0.01）. Compared with baseline data， a reduction in plasma IL-6 levels was detected in both groups （Wald χ2=22.015， 6.803， P<0.01）， and an increase in plasma IL-10 levels was reported in study group （Wald χ2=5.118， P=0.024） after 4 weeks of treatment.Conclusion Escitalopram combined with tcVNS therapy is effective in improving depressive symptoms， anxiety/somatization symptoms and sleep quality in patients with MDD. Additionally， it helps reduce plasma IL-6 levels and increase IL-10 levels. ［Funded by Shaanxi Provincial Key Research and Development Program-General Project （number， 2023-YBSF-185）， www.clinicaltrials.gov number， NCT04037111］ |
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