重复经颅磁刺激联合帕罗西汀治疗抑郁症的Meta分析  

Meta-analysis of Therapeutic Effect in Depression Treatment of Repetitive Transcranial Magnetic Stimulation Combined Paroxetine

作　　者：郭新毅 余果 何晓阔[2] GUO Xinyi;YU Guo;HE Xiaokuo(College of Rehabilitation Medicine,Fujian University of Traditional Chinese Medicine,Fuzhou,Fujian 350122,China;Taihe Hospital of Shiyan,Shiyan,Hubei 442000,China)

机构地区：[1]福建中医药大学康复医学院,福建福州350122 [2]十堰市太和医院,湖北十堰442000

出　　处：《康复学报》2019年第2期67-74,共8页Rehabilitation Medicine

基　　金：国家自然科学基金项目(81171863)

摘　　要：目的:评价重复经颅磁刺激联合帕罗西汀治疗抑郁症的临床疗效,为抑郁症的临床治疗提供参考。方法:检索中国期刊全文数据库、万方数据知识服务平台、维普中文期刊全文数据库、PubMed、EMbase、Cochrane Library,搜集重复经颅磁刺激联合帕罗西汀治疗抑郁症的随机对照试验(RCTs)。检索时限设定为建库至2017年8月31日,由2位评价者独立进行文献筛选、基本资料提取和偏倚风险评估后,采用RevMan 5.3软件进行Meta分析。结果:最终纳入16个RCTs,共1150例患者。治疗首发抑郁症的Meta分析:5篇文献以有效率为主要结局指标,显示联合治疗组与对照组比较,合并后RR=1.35,95%CI(1.11,1.65),总体效应量Z=3.00,P<0.01,两者在治疗首发抑郁症的有效率方面,差异有统计学意义;5篇文献以不良反应率为主要结局指标,显示联合治疗组与对照组比较,合并后RR=0.83,95%CI(0.56,1.24),总体效应量Z=0.92,P>0.05,两者在治疗首发抑郁症后的不良反应率方面,差异无统计学意义;3篇文献以汉密尔顿抑郁量表(HAMD)评分为次要结局指标,显示联合治疗组与对照组比较,合并后MD=-1.71,95%CI(-4.82,1.40),总体效应量Z=1.08,P>0.05,两者在改善抑郁症的HAMD评分方面,差异无统计学意义。治疗抑郁症的Meta分析:5篇文献以有效率为主要结局指标,显示联合治疗组与对照组比较,合并后RR=1.20,95%CI(0.96,1.52),总体效应量Z=1.58,P>0.05,两者在治疗抑郁症的有效率方面,差异无统计学意义;4篇文献以不良反应率为主要结局指标,显示联合治疗组与对照组比较,合并后RR=0.96,95%CI(0.68,1.34),总体效应量Z=0.26,P>0.05,两者在治疗抑郁症后的不良反应率方面,差异无统计学意义;8篇文献以HAMD评分为次要结局指标,显示联合治疗组与对照组比较,合并后MD=-3.26,95%CI(-3.83,-2.69),总体效应量Z=11.20,P<0.01,两者在改善首发抑郁症的HAMD评分方面,差异有统计学意义。结论:重复经颅磁Objective: To evaluate the therapeutic effect of repetitive transcranial magnetic stimulation(TMS) combined with paroxetine in the treatment of depression, provide reference for the clinical treatment and related research of depression. Methods: We electronically searched databases, including CNKI Chinese Journal Full-text Database, Wanfang Database, VIP Database, PubMed, the Cochrane Library and EMbase, to collect randomized controlled trials(RCTs) about depression treated by repetitive TMS combined with paroxetine. The time limitation was from the establishment of each database to 31 st August 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Then, Meta-analysis was performed by using RevMan 5.3 software. Results: A total of sixteen related articles and 1 150 patients were retrieved. The effective rate was selected as primary outcome measure in five articles, and Meta analysis showed that compared with control group, pooled RR was 1.35 with 95%CI [1.11, 1.65], Z=3.00, P<0.01, in the test for overall effect, implying the significant effective rate difference between the two groups was in the treatment of first-episode depressive. The adverse reaction rate was selected as primary outcome measure in five articles.Meta analysis showed that compared with control groups, pooled RR was 0.83 with 95%CI [0.56, 1.24], Z=0.92, P>0.05, in the test for overall effect, implying that the adverse reaction rate difference of two groups was not significant. The HAMD scores was selected as secondary outcome measure in three articles, and Meta analysis showed that compared with control groups, pooled MD was-1.71 with 95%CI [-4.82, 1.40], Z=1.08, P>0.05, in the test for overall effect, implying that the HAMD scores difference of two groups was not significant. The effective rate was selected as primary outcome measure in five articles. Meta-analysis showed that compared with control groups, pooled RR was 1.20 with 95%CI [0.96, 1.52], Z=1.58, P>0.05, in the t

关 键 词：抑郁症 重复经颅磁刺激 帕罗西汀 META分析 

分 类 号：R749.4[医药卫生—神经病学与精神病学]