低频重复经颅磁刺激治疗卒中后抑郁疗效的Meta分析  

Therapeutic efficacy of low-frequency repetitive transcranial magnetic stimulation in post-stroke depression: a Meta-analysis

作　　者：陈亮[1] 陈洁 金戈[1] 胡玲 李兴贵[1] 展群岭[1] CHEN Liang;CHEN Jie;JIN Ge;HU Ling;LI Xinggui;ZHAN Qunling(Department of Neurology, the Fifth People's Hospital of Chongqing, Chongqing 400062, China;Department of Medical Services,the Fifth People's Hospital of Chongqing, Chongqing 400062, China)

机构地区：[1]重庆市第五人民医院神经内科,重庆400062 [2]重庆市第五人民医院医务科,重庆400062

出　　处：《中国医学物理学杂志》2019年第6期736-744,共9页Chinese Journal of Medical Physics

基　　金：重庆市卫计委面上项目(2015MSXM108)

摘　　要：目的:系统评价低频重复经颅磁刺激(rTMS)治疗卒中后抑郁(PSD)的疗效。方法:计算机检索Cochrane Library、Medline、Embase、中国生物医学文献数据库(CBM),搜索有关低频rTMS治疗PSD的随机对照试验(RCTs),检索时限为建库到2017年10月。收集2005年1月~2017年10月间的相关文献,对纳入研究的文献资料采用RevMan 5.1软件进行Meta分析。结果:2005年1月~2017年10月间的相关文献符合标准的有21项RCTs,1 626例PSD患者。Meta分析结果表明:①与使用抗抑郁药组比较,0.5 Hz和1 Hz rTMS组治疗后的汉密尔顿抑郁量表(HAMD)分数降低更明显[0.5 Hz:[SMD=-0.95,95%CI(-1.19,-0.70), P<0.000 01];1 Hz:[SMD=-0.44,95%CI(-0.66,-0.23), P<0.000 1]];与空白对照组比较,0.5 Hz和1 Hz rTMS组治疗后的HAMD分数降低差异有统计学意义[0.5 Hz:[SMD=-1.35,95%CI(-1.70,-1.01),P<0.000 01];1 Hz:[SMD=-1.03,95%CI(-1.39,-0.67), P<0.000 01]]。②低频rTMS组治疗后的Barthel指数、简易精神状态检查表(MMSE)评分较对照组升高明显[Barthel指数:[SMD=1.38,95%CI(0.87, 1.89), P<0.000 01];MMSE:[SMD=0.60, 95%CI(0.31, 0.90), P<0.000 1]]。③两组治疗前后美国国立卫生院神经功能缺损评分(NIHSS)变化差异无统计学意义;④低频rTMS组会出现头痛等不良反应。结论:低频rTMS可以明显改善PSD患者的抑郁情绪,提高PSD患者的日常生活能力,改善患者的认知功能,而对于NIHSS评分改善证据尚不充分,并且可能会出现症状比较轻微并发症如头痛等,故需要进行高质量的临床研究验证。Objective To systematically assess the therapeutic efficacy of low-frequency repetitive transcranial magnetic stimulation(rTMS) in post-stroke depression(PSD). Methods The randomized controlled trials on low-frequency r TMS for post-stroke depression were retrieved from several databases, including Cochrane Library, Medline, Embase and China Biology Medicine disc(CBM), and the retrieve time range was from the establishment to October 2017. The relevant literatures from January 2005 to October 2017 were collected, and Rev Man 5.1 software was used to perform Meta-analysis on the literatures included in the study. Results Among the relevant literatures from January 2005 to October 2017, a total of 21 randomized controlled trials which included 1 626 PSD patients met the criteria. The results of Meta-analysis showed that compared with those of antidepressant group, the Hamilton depression rating scale(HAMD) score of r TMS groups(0.5 Hz and 1 Hz) decreased more obviously[0.5 Hz:[SMD=-0.95, 95%CI(-1.19,-0.70), P<0.000 01];1 Hz:[SMD=-0.44, 95%CI(-0.66,-0.23), P<0.000 1]];and that the HAMD scores of rTMS groups(0.5 Hz and 1 Hz) were significantly lower than those of control group, with statistical significance[0.5 Hz:[SMD=-1.35, 95%CI(-1.70,-1.01), P<0.000 01];1 Hz:[SMD=-1.03, 95%CI(-1.39,-0.67), P<0.000 01]].The barthel index and minimum mental state examination(MMSE) score in r TMS group were superior to those in control group[Barthel index:[SMD=1.38, 95%CI(0.87, 1.89), P<0.000 01];MMSE:[SMD=0.60, 95%CI(0.31, 0.90), P<0.000 1]]. There was no significant difference in national institute of health stroke scale(NIHSS) score between the two groups after treatment.In addition, the patients in rTMS group had adverse reactions, such as headache. Conclusion Low-frequency r TMS can significantly alleviate the depression of PSD patients, improve their daily living abilities, and enhance their cognitive functions.However, there is insufficient evidence for the improvement of NIHSS score with low-frequency r TMS. Moreover, PSD pa

关 键 词：低频重复经颅磁刺激 卒中后抑郁 META分析 

分 类 号：R312[医药卫生—基础医学] R743.3