Chronic vagus nerve stimulation in Crohn's disease: a 6-month follow-up pilot study
Chronic vagus nerve stimulation in Crohn's disease: a 6-month follow-up pilot study
复制标题
DOI：
10.1111/nmo.12792
复制
发表时间：
2016-06-01
影响因子：
3.5
通讯作者：
Pellissier, S.
中科院分区：
文献类型：
--
作者：
Bonaz, B.;Sinniger, V.;Pellissier, S.
迷走神经(VN)是连接大脑和肠道的纽带。VN是一种混合神经，通过其传入神经激活下丘脑-垂体-肾上腺轴，并通过其传出激活胆碱能抗炎途径而具有抗炎特性。我们之前已经证明，VN刺激(VNS)可以改善大鼠的结肠炎，而且克罗恩病(CD)患者的迷走神经张力会减弱。因此，我们在活动期CD患者中进行了一项关于慢性VNS的初步研究。对7名VNS患者进行了6个月的随访，主要终点是诱导临床缓解，次要终点是诱导生物学(CRP和/或粪便钙保护素)和内窥镜缓解，并恢复迷走神经张力(心率变异性)。迷走神经刺激在所有患者中都是可行的，耐受性良好。在7名患者中，2名患者在3个月后因临床恶化而退出研究，5名患者迷走神经张力恢复后临床、生物学和内窥镜检查显示病情缓解。这些结果首次证明VNS是可行的，并且似乎是治疗活动期CD的有效工具。
The vagus nerve (VN) is a link between the brain and the gut. The VN is a mixed nerve with anti-inflammatory properties through the activation of the hypothalamic-pituitary-adrenal axis by its afferents and by activating the cholinergic anti-inflammatory pathway through its efferents. We have previously shown that VN stimulation (VNS) improves colitis in rats and that the vagal tone is blunted in Crohn's disease (CD) patients. We thus performed a pilot study of chronic VNS in patients with active CD. Seven patients under VNS were followed up for 6 months with a primary endpoint to induce clinical remission and a secondary endpoint to induce biological (CRP and/or fecal calprotectin) and endoscopic remission and to restore vagal tone (heart rate variability). Vagus nerve stimulation was feasible and well-tolerated in all patients. Among the seven patients, two were removed from the study at 3 months for clinical worsening and five evolved toward clinical, biological, and endoscopic remission with a restored vagal tone. These results provide the first evidence that VNS is feasible and appears as an effective tool in the treatment of active CD.