李小娇   方继良   陈媛媛    许可   荣培晶

摘要：中国古代医家发现耳与经络及内脏的关系，故采用刺激耳廓来治疗多种疾病，其中内脏穴位（如心、肝、胃肠、肾、脾等）位于耳甲中，现代研究表明该区是体表唯一有迷走神经分布的区域，神经示踪技术表明迷走神经耳支存在直接向迷走神经感觉核-孤束核的投射纤维。十多年来，迷走神经刺激（包括最近的经耳电针迷走神经刺激）在难治性抑郁症临床研究中已被证实具有较好的抗抑郁效应，但其治疗机制尚不明确。近年来，采用脑磁共振成像技术研究发现，在治疗前后，患者孤束核、蓝斑核、杏仁核、海马、前岛叶、前扣带回等含多个边缘叶系统的脑结构明显变化，推测耳电针可能通过孤束核-边缘叶脑网络产生作用。近几年初步研究发现,无创耳电针经皮迷走神经刺激治疗可调节轻中度抑郁症患者的默认模式网络，情绪-执行控制脑区的杏仁核-背外侧前额叶功能网络；还能根据治疗前刺激时脑岛叶的反应强度来预测疗效。本文拟从脑功能MRI研究进行简要综述，为今后相应科研提供参考。

Abstract: Chinese ancient physicians found that the relationship between the ear and the meridians and internal organs, so the use of ear stimulation to treat a variety of diseases.One of the visceral acupoints (such as heart, liver, gastrointestinal, kidney, spleen, etc.) located in the concha, modern studies have shown that the area is the only vagus nerve distribution area.Neural tracing technique showed the presence of vagal nerve branch ear sensory nucleus directly to the fan-projecting fiber nucleus tractus solitarius.For more than a decade, electro-acupuncture has been shown to have a good antidepressant effect in the clinical study of the treatment resistant depression (TRD), but its therapeutic mechanism is not clear. In recent years, studies using brain MRI found before and after treatment, which patients’solitary tract nucleus, locus coeruleus, amygdala, hippocampus, anterior insula,anterior cingulate cortex and other limbic brain structures contained a plurality of significant changes. It suggests that the vagal nerve stimulation may be through the nucleus of solitary tract-limbic network. Several preliminary studies have found that noninvasive electro-acupuncture percutaneous auricular vagal nerve stimulation can regulate the default mode network of patients with mild and moderate depression, emotional-executive control of the brain amygdala-dorsolateral prefrontal function network. The efficacy can also be based on pre-treatment stimulation of cerebral insular’s response intensity. This article would make a brief review of brain function MRI research and provide reference for the VNS scientific research in the future.