重复经颅磁刺激治疗脑卒中后抑郁效果的Meta分析

Repetitive transcranial magnetic stimulation treatment of post-stroke depression:a systematic review and Meta-analysis

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.