| 李诗怡,王梦寰,王乙休,潘颖颖,林枫,江钟立.经皮耳迷走神经刺激促进卒中患者上肢功能恢复的脑网络机制的研究[J].中国康复,2025,40(4):195-201 |
| 经皮耳迷走神经刺激促进卒中患者上肢功能恢复的脑网络机制的研究 |
| Brain network mechanisms for transcutaneous auricular vagus nerve stimulation to promote functional recovery of the upper limb in stroke |
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| DOI：10.3870/zgkf.2025.04.001 |
| 中文关键词: 经皮耳迷走神经刺激 功能近红外光谱技术 脑卒中 复杂网络分析 脑网络 |
| 英文关键词: transcutaneous auricular vagus nerve stimulation functional near-infrared spectroscopy stroke complex network analysis functional brain network |
| 基金项目:江苏省重点研发计划重点项目（BE2023023-4） |
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| 中文摘要: |
| 目的：利用功能性近红外光谱技术（fNIRS）观察经皮耳迷走神经刺激（taVNS）对脑卒中并发单侧上肢运动功能障碍患者在完成主动抓握任务过程中脑激活模式的即刻效应，探索其促进上肢功能恢复的脑网络机制。方法：选取30例符合条件的脑卒中患者，随机分为taVNS组与Sham组各15例。2组均在干预前后予以心率变异性（HRV）检测。在首次HRV检测后，2组均先予以5min静息态fNIRS检测，随后分别持续予以真/假taVNS刺激，在此过程中先进行第2次5min静息态fNIRS检测，再嘱患者完成20组共700s主动抓握任务，同时进行第3次 fNIRS检测。结果：HRV结果显示taVNS组低频/高频功率比值（LF/HF）显著低于Sham组（P<0.05）；taVNS组受累侧前运动与辅助运动区（pSMA）、感觉运动度层（SMC）、非受累侧背外侧前额叶（DLPFC）及双侧眶额皮层（OFC）显著激活（P＜0.05）；基于网络的统计方法（NBS）分析显示，taVNS显著增强了受累侧PFC与非受累侧PFC、受累侧SMC与非受累侧PFC之间的功能连接，受累侧OFC的节点云集系数、局部效率显著增高（P<0.05）。taVNS组脑功能网络的全局最短路径长度增长，全局效率减小（P<0.05）。结论：即时taVNS通过激活额叶-迷走神经通路，调节双侧前额叶与运动皮层网络，从而促进相关脑区激活和功能重组，这可能是其促进上肢功能恢复的关键机制。 |
| 英文摘要: |
| Objective:To observe the immediate effects of transcutaneous auricular vagus nerve stimulation (taVNS) on the brain activation pattern of patients with unilateral upper limb motor dysfunction complicated by stroke during active grasping task by using functional near-infrared spectroscopy (fNIRS), and to explore the mechanism of the brain network that facilitates the recovery of upper limb function. Methods: Totally, 30 eligible stroke patients were randomly divided into 15 cases each in the taVNS group and the Sham group, and heart rate variability (HRV) was measured before and after the intervention in both groups. After the first HRV test, a 5-min resting state fNIRS test was performed in both groups, followed by continuous true/false taVNS stimulation in both groups, during which a second 5-min resting state fNIRS test was performed, and then the patients were instructed to complete a 20-set active grasping task for a total of 700 s, while a third fNIRS test was performed. Results: HRV results showed that the low-frequency/high-frequency power ratio (LF/HF) was significantly lower in the taVNS group than in the Sham group (P<0.05). Significant activation of the affected premotor and supplementary motor area (pSMA), sensory-motor cortex (SMC)，the unaffected dorsolatoral prefrontal cortex（DLPFC）and bilateral orbital frontal cortex（OFC）was observed in the taVNS group (P<0.05). A network-based statistical method (NBS) analysis showed that taVNS significantly enhanced the functional connectivity between the affected side PFC and the non-affected side PFC,the affected side SMC and the non-affected side PFC, and the node clustering coefficients and local efficiencies of OFC on the affected side were significantly higher (P<0.05). The taVNS group showed an increase in the global shortest path length of the functional network of the brain, and a decrease in the global efficiency (P<0.05). Conclusion: Immediate taVNS regulates bilateral prefrontal and motor cortex networks by activating the frontal-vagus pathway, thus promoting the activation and functional reorganisation of the relevant brain regions, which may be its key mechanism to promote the recovery of the upper limb. |
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