经皮耳迷走神经刺激：通过胆碱能抗炎通路实现全身炎症非侵入式调控

Transcutaneous Auricular Vagus Nerve Stimulation: Non-invasive Modulation of Systemic Inflammation via the Cholinergic Anti-Inflammatory Pathway

摘要: 近年来，经皮耳迷走神经刺激(tVNS)作为一种新兴的治疗手段，逐渐引起了医学界的关注。tVNS通过刺激耳部迷走神经，能够有效调节自主神经系统，进而影响多种疾病中的炎症反应。当前的研究显示，tVNS在减轻炎症、改善相关症状方面展现出良好的应用前景。然而，尽管已有一些成功案例，关于其具体作用机制及最佳应用方案仍需深入探讨。此外，临床应用的标准化及效果评估体系的建立也面临挑战。通过综述tVNS在抗炎作用方面的最新研究进展，本文旨在为该领域的未来研究和临床应用提供参考与启示。经皮耳迷走神经刺激属于中医药现代化的典型，该方法在临床治疗一般无需手术，能发挥一定抗炎作用，避免患者面临不良反应风险。经皮耳迷走神经刺激是将自主神经功能调整作为基础，实现外周神经–脑网络–机体调节，对癫痫、抑郁症治疗作用明显。经皮耳迷走神经刺激达到一定抗炎效果，值得临床推广和应用。经针刺和经皮耳迷走神经刺激联合应用后，轻度抑郁症患者的TNF-α、IL-6水平均降低，经神经元、免疫介导和神经内分泌介导的信号通路，能保证炎症水平降低，促使患者的抑郁症状减轻。下文按照文献筛选标准对经皮耳迷走神经刺激的解剖学、抗炎作用机制、治疗的仪器和参数详细分析，明确传统耳穴疗法和经皮耳迷走神经刺激的抗炎作用联系，阐述临床上应用经皮耳迷走神经刺激抗炎作用。

Abstract: In recent years, transcutaneous auricular vagus nerve stimulation (tVNS) has garnered increasing attention within the medical community as an emerging therapeutic intervention. By stimulating the auricular branch of the vagus nerve, tVNS effectively modulates the autonomic nervous system, thereby influencing inflammatory responses in a variety of diseases. Current research indicates that tVNS holds significant promise for ameliorating inflammation and improving associated symptoms. However, despite some successful reports, its precise mechanisms of action and optimal application protocols require further in-depth investigation. Furthermore, the standardization of its clinical use and the establishment of robust efficacy assessment frameworks present ongoing challenges. This review synthesizes recent advances in understanding the anti-inflammatory effects of tVNS, aiming to provide insights and guidance for future research and clinical translation. tVNS represents a modern interpretation of principles found in Traditional Chinese Medicine. This non-invasive method exerts anti-inflammatory effects, circumventing the risks associated with surgical interventions or adverse drug reactions. Its mechanism is grounded in the modulation of autonomic tone, facilitating a regulatory axis from the peripheral nervous system to central brain networks and systemic physiology, with demonstrated benefits in conditions such as epilepsy and depression. The appreciable anti-inflammatory efficacy of tVNS warrants its broader clinical adoption. Combining acupuncture with tVNS significantly reduced serum levels of TNF-α and IL-6 in patients with mild depression. This suggests that tVNS alleviates depressive symptoms by reducing systemic inflammation via neuronal, immune-mediated, and neuroendocrine signaling pathways. Following a systematic literature selection process, this article will critically analyze the anatomical basis of tVNS, its anti-inflammatory mechanisms, and the devices and stimulation parameters employed. It will also clarify the relationship between traditional auricular therapy and the anti-inflammatory actions of tVNS, and elaborate on its clinical application for managing inflammation.