右侧额叶低频重复经颅磁刺激治疗抑郁症的meta分析  

Efficacy of low-frequency rTMS to the right frontal cortex for depression:a meta-analysis

作　　者：鲁亚杰[1] 夏麟[1] 武圣君[1] 

机构地区：[1]第四军医大学医学心理系,西安710032

出　　处：《中国神经精神疾病杂志》2015年第6期341-348,共8页Chinese Journal of Nervous and Mental Diseases

基　　金：国家自然科学基金(编号:81401134);陕西省科学技术研究发展项目(编号:2013KJXX-90)

摘　　要：目的系统评价右侧额叶低频重复经颅磁刺激（repetitive transcranial magnetic stimulation,r TMS）治疗抑郁症的疗效。方法检索Pub Med、Web of Science、CBM、CNKI、VIP数据库中有关低频r TMS刺激右侧额叶背外侧皮质（dorsolateral prefrontal cortex,DLPFC）治疗抑郁症的临床随机对照研究（randomized controlled trials,RCT）。采用Rev Man 5.2软件,根据对照组刺激方法的不同,分别以无效刺激及高频r TMS为对照,对治疗应答率进行meta分析。结果纳入以无效刺激为对照的RCT研究9项,其中低频r TMS组156例抑郁症患者,无效刺激组162例,meta分析显示低频r TMS刺激右侧DLPFC治疗抑郁症,其治疗应答率相比无效刺激组,差异有统计学意义RR=2.15（95%CI：1.57~2.95,P〈0.01）;纳入以高频r TMS刺激左侧DLPFC为对照的RCT研究11项,其中低频r TMS组178例患者,高频r TMS组200例,meta分析表明两组间应答率差异无统计学意义（RR=0.80,95%CI：0.63~1.02,P=0.07）。结论低频r TMS刺激右侧DLPFC治疗抑郁症有效,但相比高频r TMS刺激左侧DLPFC方法而言,不具有疗效优势。Objective To systematically assess the efficacy of the low-frequency repetitive transcranial magnetic stimulation（r TMS） to the right frontal cortex for depression.Methods Clinical randomized controlled trials（RCT） studies about low-frequency r TMS to the right dorsolateral prefrontal cortex（DLPFC） for depression were collected from database such as Pub Med, SCI, CBM, CNKI, and VIP. The meta-analysis using the software of Rev Man 5.2 was conducted to compare the response rate of low-frequency r TMS to the right DLPFC with sham stimulation and high-frequency r TMS to the left DLPFC, respectively.Results Nine RCT studies with 156 patients in low-frequency r TMS group and 162 patients in sham stimulation group were included. Meta-analysis showed that low-frequency r TMS to the right DLPFC significantly improved response rate compared with sham stimulation（RR=2.15,95%CI：1.57~2.95,P0.01）. Eleven RCT studies with 178 patients in low-frequency r TMS group and 200 patients in high-frequency group were included. There was no significant difference in response rate between the two groups（RR=0.80,95%CI：0.63~1.02,P=0.07）.Conclusion The efficacy of low-frequency r TMS to the right frontal cortex for depression is significant but the efficacy is not superior in comparison with the high-frequency r TMS to left DLPFC.

关 键 词：抑郁症 重复经颅磁刺激 META分析 

分 类 号：R749.4[医药卫生—神经病学与精神病学]