经颅磁刺激不同模式干预成人难治性抑郁症的网状Meta分析  

Effects of different transcranial magnetic stimulation modes on refractory depression in adults:a network meta-analysis

作　　者：田金鑫 赵玉欣 胡通 崔甜甜 马丽虹[1] Tian Jinxin;Zhao Yuxin;Hu Tong;Cui Tiantian;Ma Lihong(College of Rehabilitation Medicine,Shandong University of Traditional Chinese Medicine,Jinan 250355,Shandong Province,China)

机构地区：[1]山东中医药大学康复医学院,山东省济南市250355

出　　处：《中国组织工程研究》2025年第35期7639-7648,共10页Chinese Journal of Tissue Engineering Research

基　　金：山东省高等医学教育研究中心科研规划课题(YJKT202112),项目负责人:马丽。

摘　　要：目的:评估经颅磁刺激治疗难治性抑郁症的疗效和安全性,并比较不同经颅磁刺激治疗方案在难治性抑郁症中的疗效差异,为临床应用经颅磁刺激治疗方案的选择提供理论依据。方法:计算机检索PubMed、Embase、Cochrane Library、Web of Science数据库、中国知网、万方数据库、中国生物医学文献数据库和维普数据库,以“经颅磁刺激,难治性抑郁症,随机对照试验”为中文检索词,以“depressive disorder,treatment-resistant,transcranial magnetic stimulation,randomized controlled trial”为英文检索词,收集从各数据库建库至2024年9月发表的关于经颅磁刺激治疗难治性抑郁症的随机对照试验。使用Cochrane 5.1.0偏倚风险评估工具和PEDro量表对纳入研究进行质量评价。采用RevMan 5.4和Stata 18.0软件对结局指标进行Meta分析。结果:①纳入20项随机对照试验,根据PEDro量表评估这些试验均为高质量或极高质量。②Meta分析显示,与伪刺激组相比,高频重复经颅磁刺激可显著降低汉密尔顿抑郁量表评分(MD=-3.89,95%CI:-6.14至-1.65,P<0.05)或蒙哥马利抑郁量表评分(MD=-3.97,95%CI:-6.57至-1.36,P<0.05)。③网状Meta分析概率排序结果:在汉密尔顿抑郁量表评分方面,高频重复经颅磁刺激(69.9%)>间歇性爆发性θ刺激(62.8%)>双侧θ脉冲刺激(57.5%)>低频重复经颅磁刺激(54.9%)>双侧顺序重复经颅磁刺激(49.0%)>经颅脉冲电磁场(37.0%)>伪刺激(18.9%);在蒙哥马利抑郁量表评分方面,高频重复经颅磁刺激(93.3%)>双侧θ脉冲刺激(50.3%)>伪刺激(45.9%)>低频重复经颅磁刺激(32.1%)>双侧顺序重复经颅磁刺激(28.4%)。结论:经颅磁刺激可改善难治性抑郁症患者的抑郁症状,其中高频重复经颅磁刺激模式对改善难治性抑郁症患者的抑郁症状效果最佳,其次为间歇性爆发性θ刺激模式。OBJECTIVE:To assess the efficacy and safety of transcranial magnetic stimulation in the treatment of refractory depression and to compare the differences in efficacy between various transcranial magnetic stimulation treatment protocols in refractory depression,thereby providing a theoretical basis for the clinical selection of transcranial magnetic stimulation treatment protocols.METHODS:A comprehensive search was conducted across multiple databases,including PubMed,Embase,Cochrane Library,Web of Science,CNKI,WanFang Data,CBM and VIP.The search terms were“transcranial magnetic stimulation,treatment-resistant depression,randomized controlled trial”in Chinese,and“depressive disorder,treatment-resistant,transcranial magnetic stimulation,randomized controlled trial”in English.The objective was to identify randomized controlled trials on the treatment of patients with refractory depression published from the establishment of the databases to September 2024.The quality of the included studies was evaluated using the Cochrane risk of bias assessment tool,version 5.1.0,and the Physiotherapy Evidence Database scale.Meta-analysis of the outcome indicators was conducted using the Review Manager 5.4 and Stata 18.0 software.RESULTS:(1)Following a comprehensive review,20 randomized controlled trials were included in the analysis.All of the trials were assessed to be of high or very high quality according to the Physiotherapy Evidence Database scale.(2)Meta-analysis results showed that,compared with the sham stimulation group,high-frequency repetitive transcranial magnetic stimulation could significantly reduce the scores of Hamilton Depression Rating Scale[mean difference(MD)=-3.89,95%confidence interval(CI):-6.14 to-1.65,P<0.05)or the Montgomery Depression Rating Scale(MD=-3.97,95%CI:-6.57 to-1.36,P<0.05).(3)The probability ranking results of the network Meta-analysis showed that,in terms of the Hamilton Depression Rating Scale score,the probability ranking results were as follows:high-frequency repetitive transcrania

关 键 词：难治性抑郁症 经颅磁刺激 高频重复经颅磁刺激 低频重复经颅磁刺激 双侧顺序重复经颅磁刺激 间歇性爆发性θ刺激 双侧θ脉冲刺激 经颅脉冲电磁场 网状Meta分析 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R749