【目的】探讨经皮耳穴迷走神经刺激 （taVNS） 对超重/肥胖患者的治疗效果，并分析其中枢效应机制。 【方法】将26例超重/肥胖患者随机分为经皮耳穴迷走神经刺激试验组 （简称taVNS组） 12例和生活方式干预对照组 （简称对照组） 14例，对照组患者采用基于能量限制饮食模式 （CRD） 的线上生活方式干预，taVNS组患者在对照组的基础上采用taVNS治疗，每次治疗单侧耳朵 （选择穴位包括脾点、内分泌点） ，每天早晚2次，每周治疗5 d，共治疗4周。观察2组患者治疗前后的体质量、体质量指数 （BMI） 、腰围等肥胖指标的变化情况，同时采集患者治疗后的脑部静息态磁共振功能成像 （fMRI） 数据，通过局部一致性 （ReHo） 的分析方法，观察taVNS对患者脑区ReHo的调节作用。 【结果】（1） 脱落情况方面：研究过程中，2组各脱落1例，最终共有24例患者 （包括对照组13例和taVNS组11例） 纳入观察指标的统计分析。 （2） 肥胖指标改善方面：治疗后，taVNS组患者的体质量、BMI、腰围均较治疗前下降 （P＜0.05） ，而对照组患者的体质量、BMI、腰围均较治疗前有下降趋势，但差异均无统计学意义 （P＞0.05） ；taVNS组对体质量、BMI、腰围等肥胖指标的改善作用均明显优于对照组，组间治疗后和治疗前后差值比较，差异均有统计学意义 （P＜0.05或P＜0.01） 。 （3） fMRI 结果方面：治疗后，taVNS组ReHo值大于对照组的脑区有左侧前额叶、额内侧回，对照组ReHo值大于taVNS组的脑区有右侧顶叶。提示与对照组比较，taVNS组左侧前额叶、额内侧回的ReHo增高，右侧顶叶的ReHo降低 （Pvoxel＜0.001，Pcluster＜0.05，FWE水平校正） 。 【结论】taVNS作为一种无创治疗手段，对超重/肥胖患者有一定的疗效，taVNS对左侧前额叶、额内侧回、右侧顶叶等相关区域功能的调节可能是其治疗肥胖的中枢效应机制。

Objective To investigate the therapeutic effect of transcutaneous auricular vagus nerve stimulation （taVNS） on overweight/obesity patients，and to explore its central mechanism. Methods Twenty-six overweight/obesity patients were randomly divided into two groups，12 cases in the taVNS test group （shortened as the taVNS group） and 14 cases in the lifestyle intervention control group （shortened as the control group） . The patients in the control group were treated with online lifestyle intervention of calorie-restricted diet （CRD），and the patients in the taVNS group were treated with taVNS on the basis of the intervention for the control group. The taVNS was performed on unilateral acupoints of spleen and endocrine，twice （in the morning and at evening） per day，for five days a week. The treatment for the two groups covered four weeks. The obesity indicators such as body weight，body mass index （BMI） and waist circumference of the patients in the two groups were observed before and after treatment. Moreover，the resting-state cerebral functional magnetic resonance imaging （fMRI） data of the patients were collected after treatment，and then the regulatory effect of taVNS on the regional homogeneity （ReHo）of local cerebral area of the patients was observed. Results （1） During the trial，one case in each group dropped off，and a total of 24 patients （including 13 cases in the control group and 11 cases in the taVNS group） were finally included in the statistical analysis of the observation indicators. （2） After treatment，the body weight，BMI and waist circumference of patients in the taVNS group were decreased compared with those before treatment （P＜0.05） ，while the obesity indicators in the control group only showed a downward trend compared with those before treatment，the differences being not statistically significant（P＞0.05） . The improvement of the obesity indicators of body weight，BMI，and waist circumference in the taVNS group was significantly superior to that in the control group，and there were statistically significant differences in the post-treatment indicators and in the pre- and post-treatment difference values of the indicators between the two groups （P＜0.05 or P＜0.01） . （3） After treatment，the taVNS group had greater ReHo values in the left prefrontal lobe and medial frontal gyrus than the control group，and the control group had greater ReHo value in the right parietal lobe than the taVNS group，which indicated that compared with the control group，the ReHo of the left prefrontal lobe and medial frontal gyrus in the taVNS group was increased and the ReHo of the right parietal lobe was decreased （Pvoxel ＜0.001，Pcluster＜0.05，corrected by FWE level） . Conclusion As a non-invasive treatment method，taVNS exerts certain efficacy for the treatment of overweight/obesity patients. The central response mechanism for treatment of obesity is probably related with the modulation of taVNS on the functional areas of left prefrontal lobe，medial frontal gyrus，and right parietal lobe of the patients.

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广东省自然科学基金项目 （编号：2019A1515011504）；省部共建中医湿证国家重点实验室科研专项 （编号：SZ2021ZZ08，SZ2022KF14）