基于fNIRS的脑功能评估：针灸干预抑郁症的神经机制研究进展

Advances in fNIRS-Based Brain Functional Assessment: Neural Mechanisms of Acupuncture Intervention in Depression

摘要: 目的：抑郁症是一种常见的精神障碍，其核心症状包括持续的情绪低落、兴趣减退以及认知功能下降，严重影响患者的生活质量和社会功能。尽管现有的抗抑郁治疗手段如药物和心理治疗已被广泛应用，但疗效的个体差异大、副作用明显等问题仍然存在。因此，探索安全有效的替代或辅助疗法成为当前研究的重要方向。针灸作为中国传统医学的重要组成部分，近年来被证实具有缓解抑郁症状的潜力。功能性近红外光谱成像(functional Near-Infrared Spectroscopy, fNIRS)作为一种非侵入性、便携性强的脑功能成像技术，在评估针灸干预对抑郁症患者的神经机制方面展现出独特优势。本文旨在系统综述基于fNIRS的研究成果，探讨针灸干预抑郁症的神经机制及其对关键脑区功能的影响。方法：通过检索PubMed、CNKI、万方等数据库，收集了近年来关于针灸治疗抑郁症并结合fNIRS进行脑功能评估的相关文献。从fNIRS的技术原理出发，分析其在监测针灸干预前后大脑不同区域氧合血红蛋白浓度变化的能力，从而反映局部脑区激活状态的变化。同时，综合已有研究，探讨针灸如何通过调节前额叶皮层与边缘系统之间的功能连接来发挥抗抑郁作用。此外，还从脑区激活模式、网络连接重塑、临床症状改善等多个维度对现有研究成果进行了归纳与分析。结果：多项研究表明，抑郁症患者普遍存在前额叶皮层(Prefrontal Cortex, PFC)，尤其是左侧背外侧前额叶皮层(Dorsolateral Prefrontal Cortex, DLPFC)的功能减退现象。而接受针灸干预后，患者的抑郁症状显著改善，并伴随fNIRS检测到的氧合血红蛋白浓度上升及相应脑区激活增强。特别是在执行情绪识别或工作记忆任务时，左侧DLPFC的激活水平显著提高，提示针灸可能有助于恢复该区域的正常功能。此外，fNIRS研究还揭示了针灸可能通过增强PFC与边缘系统(如杏仁核、海马)之间的功能连接，改善默认模式网络(Default Mode Network, DMN)与突显网络(Salience Network, SN)之间的协调性，从而提升患者的情绪调节能力。例如，刺激百会穴(GV20)联合神门穴(HT7)相较于其他配穴方式，更能有效增强PFC的激活水平并优化脑网络整合。结论：fNIRS为针灸治疗抑郁症的神经机制研究提供了客观、可量化的脑功能评估手段，具有良好的临床应用前景。它不仅能够捕捉针灸引起的局部脑区激活变化，还能揭示其对整体脑网络动态调控的作用机制。随着fNIRS设备的便携化与数据分析方法的不断进步，其在针灸干预抑郁症研究中的应用前景广阔，有望为针灸在精神科领域的推广应用提供坚实的科学依据。

Abstract: Objective: Depression is a common mental disorder characterized by persistent low mood, loss of interest, and cognitive impairment, which significantly impairs patients’ quality of life and social functioning. Although current antidepressant treatments—such as pharmacotherapy and psychotherapy—are widely used, challenges remain, including substantial inter-individual variability in treatment response and notable side effects. Therefore, exploring safe and effective alternative or adjunctive therapies has become a key focus in current research. Acupuncture, a core component of traditional Chinese medicine, has recently demonstrated potential in alleviating depressive symptoms. Functional near-infrared spectroscopy (fNIRS), a non-invasive and highly portable neuroimaging technique, offers unique advantages in evaluating the neural mechanisms underlying acupuncture interventions for depression. This paper aims to systematically review fNIRS-based research findings to elucidate the neural mechanisms of acupuncture in treating depression and its effects on key brain regions. Methods: Literature on acupuncture for depression combined with fNIRS-based brain functional assessment was retrieved from databases including PubMed, CNKI, and Wanfang. Starting from the technical principles of fNIRS, we analyzed its capacity to monitor changes in oxyhemoglobin concentration across different brain regions before and after acupuncture, thereby reflecting alterations in local cortical activation. Existing studies were synthesized to explore how acupuncture may exert antidepressant effects by modulating functional connectivity between the prefrontal cortex (PFC) and the limbic system. Furthermore, current findings were summarized and analyzed across multiple dimensions, including patterns of regional brain activation, network connectivity reorganization, and clinical symptom improvement. Results: Multiple studies have consistently reported hypoactivation in the prefrontal cortex (PFC)—particularly the left dorsolateral prefrontal cortex (DLPFC)—in individuals with depression. Following acupuncture intervention, patients exhibited significant clinical improvement, accompanied by increased oxyhemoglobin concentration and enhanced activation in these regions as detected by fNIRS. Notably, during emotional recognition or working memory tasks, activation in the left DLPFC was markedly elevated, suggesting that acupuncture may help restore normal function in this critical area. Moreover, fNIRS studies indicate that acupuncture may enhance functional connectivity between the PFC and limbic structures (e.g., amygdala, hippocampus) and improve the coordination between the default mode network (DMN) and the salience network (SN), thereby bolstering emotional regulation. For instance, stimulation of Baihui (GV20) combined with Shenmen (HT7) demonstrated superior efficacy in enhancing PFC activation and optimizing brain network integration compared to other acupoint combinations. Conclusion: fNIRS provides an objective and quantifiable tool for investigating the neural mechanisms of acupuncture in depression, holding strong promise for clinical application. It not only captures localized changes in cortical activation induced by acupuncture but also reveals its modulatory effects on large-scale brain network dynamics. With ongoing advances in portable fNIRS hardware and analytical methodologies, its role in acupuncture research for depression is poised to expand significantly, offering robust scientific evidence to support the broader integration of acupuncture into psychiatric practice.