华西医学

华西医学

重复经颅磁刺激治疗脑卒中后抑郁效果的 Meta 分析

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目的系统评价重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)治疗脑卒中后抑郁(post-stroke depression,PSD)的效果。方法计算机检索 PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方数据库、维普数据库和中国生物医学文献数据库,限定检索年限为 2013 年 1 月—2018 年 4 月,文献类型为随机对照试验,rTMS 组为接受 rTMS 加药物治疗或常规处理的 PSD 患者,对照组为在药物治疗或常规处理的同时采用或不采用 rTMS 假刺激的 PSD 患者。由 2 名研究员独立进行文献质量评价和资料提取后运用 RevMan 5.3 和 Stata 14.0 软件进行 Meta 分析。结果纳入 18 篇文献,共 1 376 例 PSD 患者,其中 rTMS 组 687 例,对照组 689 例。rTMS 组较对照组能有效降低 PSD 患者的抑郁评分[标准化均数差(standard mean difference,SMD)=–1.13,95% 置信区间(confidence interval,CI)(–1.42,–0.84),P<0.000 01],rTMS 治疗 PSD 的有效率为 91.7%,同时,rTMS 组能更好地促进 PSD 患者神经功能缺损的恢复[SMD=–1.00,95%CI(–1.25,–0.75),P<0.000 01]和日常生活能力的提高[SMD=1.56,95%CI(0.80,2.32),P<0.000 01]。经亚组分析和 Meta 回归分析,均未发现异质性来源。纳入研究在 rTMS 治疗期间,均未出现明显不良反应。结论rTMS 对 PSD 患者的抑郁情绪、神经功能缺损和日常生活能力减退有积极的治疗作用,限于纳入研究的质量水平,上述结论需进一步验证。

ObjectiveTo systematically evaluate the effect of repetitive transcranial magnetic stimulation (rTMS) on post-stroke depression (PSD).MethodsWe searched databases including the PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Internet, Wanfang, China Biology Medicine database and VIP database to collect randomized controlled trials comparing the effect of the rTMS group and the control group with the scores of depression scale from January 2013 to April 2018. Patients in the rTMS group received rTMS plus drug therapy or conventional treatment for PSD, and patients in the control group received rTMS sham stimulation or not, but the drug treatment or routine treatment was required. When the quality evaluation and data extraction were carried out by two reviewers independently, the Meta-analysis was performed using RevMan 5.3 software and Stata 14.0 software.ResultsA total of 18 literatures involving 1 376 patients (687 patients in the rTMS group and 689 patients in the control group) with PSD were included in this Meta-analysis. Compared with the control group, the rTMS group could effectively reduce the depression scores of PSD patients [standard mean difference (SMD)=–1.13, 95% confidence interval (CI) (–1.42, –0.84), P<0.000 01], and the effective rate of rTMS was 91.7%; meanwhile, rTMS could promote the scores of the National Institute of Health Stroke Scale and the activities of daily living of patients with PSD [SMD=–1.00, 95%CI (–1.25, –0.75), P<0.000 01;SMD=1.56, 95%CI (0.80, 2.32), P<0.000 01]. The source of heterogeneity was not found according to subgroup analysis and Meta-regression analysis. Additionally, few studies reported adverse reactions after the treatment of rTMS.ConclusionsrTMS has a positive effect on depression, neurological deficits, and decreased ability of daily living in patients with PSD. Due to the quality of the included studies, the conclusions need to be verified further.

关键词: 重复经颅磁刺激; 脑卒中; 抑郁; Meta 分析

Key words: Repetitive transcranial magnetic stimulation; Stroke; Depression; Meta-analysis

引用本文: 刘超猛, 王梅子, 张桂青. 重复经颅磁刺激治疗脑卒中后抑郁效果的 Meta 分析. 华西医学, 2018, 33(10): 1287-1294. doi: 10.7507/1002-0179.201805077 复制

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