重复经颅磁刺激治疗强迫障碍的有效性和安全性meta分析  

Meta-Analysis of the Effectiveness and Safety of Repetitive Transcranial Magnetic Stimulation in the Treatment of Obsessive-Compulsive Disorder

作　　者：李文峰 朱俊敬 贾得焕 王淑贤 宋延艳 孔德荣 李猛 LI Wenfeng;ZHU Junjing;JIA Dehuan;WANG Shuxian;SONG Yanyan;KONG Derong;LI Meng(Department of Psychiatry,the Eighth People’s Hospital of Zhengzhou,Zhengzhou 450006,China)

机构地区：[1]郑州市第八人民医院精神科,河南郑州450006

出　　处：《河南医学研究》2025年第7期1161-1167,共7页Henan Medical Research

摘　　要：目的系统评价重复经颅磁刺激治疗(rTMS)治疗强迫障碍(OCD)的效果和安全性。方法计算机检索PubMed、Cochrane Library、Embase、Web of Science、CNKI、万方数据库、维普中文科技期刊、SinoMed数据库,查询所有rTMS治疗OCD的随机对照试验(RCT),检索的时限均从建库至2023年10月14日。本研究由2名独立研究者筛选文献、提取所需资料和评价纳入研究的偏倚风险后,使用RevMan 5.4和Stata 17.0软件进行meta分析。结果研究纳入22项RCT,涉及942例OCD患者,治疗组为481例,对照组为461例。meta分析结果显示,治疗后两组耶鲁-布朗强迫量表(Y-BOCS)评分合并后的Hedges’s g为-0.51(95%CI:-0.87~-0.34,Z=-5.46,P<0.01)。亚组分析显示刺激频率1 Hz组合并后Hedges’s g为-0.61(95%CI:-0.69~-0.33,Z=33.47,P<0.01),刺激右侧背外侧前额叶皮层(DLPFC)脑区的Hedges’s g为-0.70(95%CI:-1.02~-0.39,Z=26.65,P<0.01)。治疗后两组汉密尔顿焦虑量表(HAMA)评分合并后的Hedges’s g为-0.57(95%CI:-0.80~-0.34,Z=-4.86,P<0.01)。两组退出率合并后的比值比(OR)值0.17(95%CI:-0.38~0.73,Z=0.60,P=0.55)。结论rTMS治疗OCD有效,不良反应少,特别是频率为1 Hz、刺激DLPFC脑区效果显著。Objective Systematic evaluation of the efficacy and safety of repetitive transcranial magnetic stimulation(rTMS)in the treatment of obsessive-compulsive disorder(OCD).Methods The computer searched PubMed,Cochrane Library,Embase,Web of Science,CNKI,Wanfang Database,VIP Chinese Science and Technology Journal,and SinoMed Database to search all randomized controlled trials(RCTs)for rTMS treatment of OCD.The search time limit was from the database establishment to October 14,2023.After 2 independent researchers screened literature,extracted the required data and evaluated the risk of bias in the included study,meta-analysis was performed using RevMan 5.4 and Stata 17.0 software after the study was performed.Results The study included 22 RCTs,involving 942 OCD patients,481 in the treatment group and 461 in the control group.The results of meta analysis showed that after treatment,the combined Hedges’s g of Yale-Brown obsessive-compulsive scale(Y-BOCS)of the two groups was-0.51(95%CI:-0.87--0.34,Z=-5.46,P<0.01).Subgroup analysis showed that the Hedges’s g of the combined 1 Hz group was-0.61(95%CI:-0.69--0.33,Z=33.47,P<0.01),and the Hedges’s g of stimulating the granular dorsolateral prefrontal cortex(DLPFC)brain area was-0.70(95%CI:-1.02--0.39,Z=26.65,P<0.01).After treatment,the combined Hedges’s g of Hamilton anxiety scale(HAMA)score of the two groups was-0.57(95%CI:-0.80--0.34,Z=-4.86,P<0.01).The OR value of the combined withdrawal rate of the two groups was 0.17(95%CI:-0.38-0.73,Z=0.60,P=0.55).Conclusion rTMS is effective in the treatment of OCD with few adverse reactions,especially in the frequency of 1 Hz and stimulating the brain area of DLPFC.

关 键 词：强迫障碍 重复经颅磁刺激 META分析 随机对照试验 

分 类 号：R749.3[医药卫生—神经病学与精神病学]