重复经颅磁刺激治疗强迫症随机对照双盲研究的meta分析

Repetitive transcranial magnetic stimulation (rTMS) for obsessive compulsive disorder (OCD): A meta-analysis of randomized,double-blind and sham-controlled trials

目的:系统评价重复经颅磁刺激(rTMS)治疗治疗强迫症(OCD)的疗效。方法:计算机检索Pubmed、Web of Science、Google Scholar、中国知网期刊全文数据库、万方数据库、维普中文科技期刊所有关于rTMS治疗OCD患者的随机对照双盲试验,同时筛检纳入文献的参考文献。对符合纳入标准的文献使用CMA 2.0软件对文献数据进行统计学分析。结果:最终纳入16篇随机对照双盲临床研究,共有强迫症患者543例。Meta分析结果显示,与安慰剂rTMS组相比,rTMS组可有效的改善患者的强迫症状,合并的Hedge's g值为0.65,(95%CI=0.34～0.96,Z=4.12,P<0.001),总体有效率54.6%,合并的OR值为3.28(95%CI=1.79～6.00,Z=3.85,P<0.001);亚组分析结果显示,rTMS组较安慰剂rTMS组显示在高频(Hedge's g=0.54,95%CI=0.23～0.84,Z=3.39,P=0.001)、低频(Hedge's g=0.80,95%CI=0.25～1.35,Z=2.86,P=0.004)、刺激部位为背外侧前额叶(DLPFC)(Hedge's g=0.60,95%CI=0.31～0.89,Z=3.99,P<0.001)均更能改善患者的强迫症状。rTMS组与安慰剂rTMS组退出率差异无统计学意义。结论:现有数据提示高频、低频刺激部位为DLPFC区rTMS治疗强迫症有效。

Objective： To assess the effectiveness of repeated transcranial magnetic stimulation（ rTMS） in relieving obsessive compulsive disorder（OCD）. Methods： PubMed,Web of Science,Embase,Cochrane Library,GoogleScholar,CNKI,WANGFANG and VIP were searched for reports of double blind,randomized controlled study of rTMS treatment of OCD published before November 2016. Meta-analysis was conducted by using CMA 2. 0 software. The meta-analysis with the main outcome measures as pre-post changes in Yale-Brown Obsessive Compulsive Scale（Y-BOCS） scores,response to treatment and overall dropout rates at study end were analyzed. Results： Data were obtained from 16 double blind RCTs,totaling 543 subjects with OCD. The pooled Hedges＇ g for pre-post Y-BOCS scores was 0. 65（95%CI： 0. 34-0. 96,Z = 4. 12,P〈0. 001） indicating a significant difference in outcome favoring active rTMS. Furthermore,the overall effective rate was 54. 6 for patients receiving active rTMS（OR = 3. 28,Z = 3. 85,P〈0. 001）. Sub-group analyses indicated that low frequency rTMS（LF-rTMS） and high frequency rTMS（HF-rTMS） protocols targeting DLPFC regions seemed to be the most promising for reducing OCD-related symptoms. No differences dropout rates at study end were observed between active and sham rTMS groups. Conclusions： The meta-analyses shows that active rTMS appears to be a safe and effective therapy for obsessive compulsive disorder.