重复经颅磁刺激与改良电休克治疗抑郁症疗效比较的Meta分析  

A meta-analysis of repetitive transcranial magnetic stimulation versus modified electroconvulsive therapy in the treatment of depression

作　　者：屠丽回 付倩芝 李日鹏[1] Tu Lihui, Fu Qianzhi, Li Ripeng.(Department of Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University （ Guangzhou Huiai Hospital）, Guangzhou 510370, China)

机构地区：[1]广州医科大学附属脑科医院(广州市惠爱医院)精神科,510370

出　　处：《中华精神科杂志》2018年第2期125-132,共8页Chinese Journal of Psychiatry

基　　金：广东省医学科研基金项目（卫生厅）（B2016109）

摘　　要：目的系统评价改良电休克治疗（electroconvulsive therapy，ECT）与重复经颅磁刺激（repetitive transcranial magnetic stimulation，rTMS）治疗抑郁症的疗效差异。方法检索Pubmed、Embase、Web of science、Cochrane library及中国期刊全文数据库、万方数据库和中国生物医学文献数据库，检索时间为各数据库建库至2017年3月31日，搜索关键词包括＂transcranial magnetic stimulation＂＂TMS＂＂electroconvulsive therapy＂＂ECT＂＂depression＂＂经颅磁刺激＂＂电休克＂＂抑郁症＂等。收集比较rTMS与ECT治疗抑郁症的对照研究，选取治疗后的有效率为主要疗效指标，治疗后汉密尔顿抑郁评定量表（Hamilton Depression Rating Scale，HDRS）评分、缓解率为次要疗效指标，同时比较失访率。采用Revman 5.3软件进行Meta分析。结果14篇随机对照研究共671例患者满足纳入标准。rTMS总的治疗有效率（OR=0.71，95%CI：0.46-1.10，P=0.120）、缓解率（OR=0.67，95%CI：0.39-1.15，P=0.140）及失访率（OR=0.48，95%CI：0.23-1.01，P=0.050）与ECT差异无统计学意义；亚组分析显示，对伴有精神病性症状的抑郁症，ECT疗效优于rTMS（OR=0.27，95%CI：0.12-0.60，P=0.001）；治疗后HDRS评分ECT显著低于rTMS（MD=2.04，95%CI：0.58-3.50，P=0.006）。结论rTMS治疗抑郁症总的有效率、缓解率及临床可耐受度与ECT相当，ECT对伴有精神病性症状的抑郁症疗效更好。Objective To systematically review the effectiveness of repetitive transeranial magnetic stimulation .（rTMS） versus modified electroeonvulsive therapy （ECT） on efficacy of treating depression. Methods Pubmed, Embase,Web of seience,Cochrane library, CNKI, WanFang Data and CBM were searched since the database establishment till March in 2017 for randomized controlled trials （RCTs） that compared the efficacy of rTMS and ECT on depression mainly by assessment of response rate, and the mean Hamilton Depression Rating Scale （HDRS） score and remission rate. The dropout rate was also analyzed. The meta-analysis was performed by using RevMan 5.3 software. Results Fourteen RCTs involving 671 patients were finally included. The results showed that there was no significant difference between two therapies on the response rate （OR=0.71, 95%CI： 0.46-1.10, P=0.120）, remission rate （OR= 0.67, 95 %CI： 0.39-1.15, P=0.140） and dropout rate（OR=0.48, 95%CI： 0.23-1.01, P=0.050）. Subgroup analysis showed ECT was more effective on psychotic depression（OR=0.27, 95%CI： 0.12-0.60, P=0.001）. Moreover, mean HDRS score after the ECT was significantly lower than rTMS treatment （MD=2.04, 95%CI： 0.58-3.50, P=0.006）. Conclusion rTMS has the same efficacy and acceptability as ECT for depression treatment, and ECT seems to be advantageous on psychotic depression.

关 键 词：抑郁症 经颅磁刺激 电惊厥疗法 META分析 

分 类 号：R749.4[医药卫生—神经病学与精神病学]