星状神经节阻滞在焦虑和抑郁治疗中的机制研究进展

摘要

星状神经节阻滞（SGB）作为一种经典的交感神经调控技术,近年来逐渐被用于焦虑、抑郁及创伤后应激障碍等情绪障碍的辅助治疗研究。焦虑和抑郁的发生发展与自主神经系统失衡、下丘脑-垂体-肾上腺轴持续激活以及炎症免疫反应异常密切相关,而星状神经节位于颈胸交感链关键部位,参与心血管稳态、应激反应和情绪调节等多种生理过程。现有研究提示,SGB可通过阻断颈胸交感神经传导,降低交感神经过度兴奋,改善交感-副交感神经动态平衡,提高心率变异性,从而缓解焦虑、恐惧、高警觉、心悸、出汗及睡眠障碍等症状。同时,SGB可能通过减弱外周交感反馈输入,调节下丘脑-垂体-肾上腺轴功能,降低皮质醇水平,恢复应激内分泌稳态,并进一步改善慢性应激相关的情绪异常。此外,SGB还可能通过抑制去甲肾上腺素介导的促炎反应、调节NF-κB相关炎症通路以及增强迷走神经介导的胆碱抗炎效应,降低TNF-α、IL-6、IL-1β等炎症因子水平,从神经免疫层面发挥抗焦虑、抗抑郁作用。总体来看,SGB可能代表一种“外周自主神经调控-中枢情绪网络改善”的自下而上干预模式,为情绪障碍的快速缓解和个体化治疗提供了新的思路。然而,目前相关研究仍存在样本量较小、研究设计异质性较大、操作参数缺乏统一标准及长期随访不足等问题。未来仍需开展多中心、随机对照和长期随访研究,并结合神经影像学、生理指标及炎症标志物评估,进一步明确SGB在焦虑和抑郁治疗中的疗效边界、适用人群及作用机制。

关键词

星状神经节阻滞 / 焦虑 / 抑郁 / 自主神经调控

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基金资助

河北省卫生健康委员会医学科学研究课题（20231081）