重复经颅磁刺激治疗卒中后抑郁的Meta分析

Meta analysis of repetitive transcranial magnetic stimulation treating post-stroke depression

目的探讨重复经颅磁刺激治疗卒中后抑郁的效果。方法计算机检索英文数据库(包括PubMed、PsycINFO、EMbase和Cochrane Library),并纳入关于重复经颅磁刺激治疗卒中后抑郁的随机对照研究(RCT),以上数据库的检索时限至2018年6月15日,同时手工检索相关的已发表文献。由两位研究者独立地进行文献检索、筛选符合纳排标准的RCT、数据提取和方法学质量评估(使用偏倚风险评估工具)后,应用Revman 5.3软件进行Meta分析。结果共3篇RCTs(n=81)随机分为复经颅磁刺激治疗组(n=41)和对照组(n=40),其中,高频刺激2篇RCTs,低频刺激1篇RCT。文献质量评定结果显示,仅1篇RCT(33.3%)在分配隐藏上被评为低危。Meta分析结果显示,干预结束时(5 d～4周),重复经颅磁刺激治疗组改善抑郁症状的效果优于对照组(合并的SMD值=-1.45,95%CI=-2.45～-0.45,P=0.004)。结论重复经颅磁刺激在一定程度上能改善卒中后抑郁。但考虑到符合纳排标准的RCTs较少和研究的方法学信息不完善等不足,今后需要多中心、高质量的RCTs来验证该结论。

Objective To explore the effect of repetitive transcranial magnetic stimulation(rTMS)treating post-stroke depression(PSD).Methods English databases including PubMed,PsycINFO,EMbase,and Cochrane Library were searched using computer,and the randomized controlled study(RCT)on repetitive transcranial magnetic stimulation treating PSD was included.The searching time was limited to June 15,2018.At the same time,relevant published literature was retrieved manually.After independently searching for literature,screening RCT that meeting the inclusion criteria,data extraction and methodological quality assessment(using biased risk assessment tools),the two researchers used Revman 5.3 software for Meta analysis.Results A total of three RCTs were randomly divided into the rTMS treating group(n=41)and control group(n=40),among them,there were 2 RCTs with high frequency stimulation and 1 RCT with low frequency stimulation.The results of literature quality assessment showed that only 1 RCT(33.3%)was rated as low risk in allocation concealment.Meta analysis results showed that at the end of the intervention(5 days to 4 weeks),the effect of rTMS treating group on depressive symptoms was better than that of the control group(combined SMD=-1.45,95% CI=-2.45-0.45,P=0.004).Conclusion rTMS can improve PSD to some extent.However,considering the lack of RCTs that meeting the inclusion criteria and the imperfect methodological information,multi-center and high-quality RCTs are needed to verify this conclusion in the future.