不同方式重复经颅磁刺激联合SSRI对卒中后抑郁患者干预效果的网状Meta分析

Efficacy of different modalities of repetitive transcranial magnetic stimulation combined with SSRIs on post-stroke depressed patients:a network meta-analysis

目的对不同方式重复经颅磁刺激(rTMS)联合SSRI类抗抑郁药物对脑卒中后抑郁患者的干预效果进行网状Meta分析。方法计算机检索PubMed、EMbase、Cochrane Library、Web of Science、CNKI、VIP、CBM和WanFang Data数据库,搜集与研究目的相关的随机对照试验(RCT),检索时限均为建库至2022年10月1日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用R 4.2.1软件进行网状Meta分析。结果最终纳入25个RCT,包括2152例患者,涉及联合SSRI的4种rTMS刺激方式,即高频刺激左背外侧前额叶(l-DLPFC)、低频刺激l-DLPFC、低频刺激右背外侧前额叶(r-DLPFC)和低频刺激双侧背外侧前额叶(DLPFC)。网状Meta分析结果显示,4种刺激方式联合SSRI治疗抑郁的效果均优于单独使用SSRI(P<0.05)。最佳概率排序结果显示,低频刺激双侧DLPFC(88.9%)>低频刺激l-DLPFC(63.1%)>高频刺激l-DLPFC(57.1%)>低频刺激r-DLPFC(40.4%)。4种刺激方式联合SSRI与单独使用SSRI的不良反应发生率差异无统计学意义(P>0.05)。结论rTMS联合SSRI在卒中后抑郁情绪改善方面效果均优于单独SSRI治疗,其中低频rTMS刺激双侧DLPFC的效果可能最佳。同时,不同刺激方式的安全性均较好。

Objective To systematically review the efficacy of different stimulation modalities of repetitive transcranial magnetic stimulation(rTMS)combined with SSRI in improving depressed mood after stroke using network meta-analysis.Methods The PubMed,EMbase,Cochrane Library,Web of Science,CNKI,VIP,CBM and WanFang Data databases were electronically searched to collect randomized controlled trials(RCTs)related to the objectives from inception to October 1,2022.Two reviewers independently screened literature,extracted data and assessed the risk of bias of the included studies.Network meta-analysis was then performed by using R 4.2.1software.Results A total of 25 RCTs involving 2152 patients were included.Four types of rTMS stimulation combined with SSRIs were included:highfrequency stimulation of the left dorsolateral prefrontal(l-DLPFC),low-frequency stimulation of l-DLPFC,low-frequency stimulation of the right dorsolateral prefrontal(r-DLPFC),and low-frequency stimulation of the bilateral DLPFC.The results of the network meta-analysis showed that the effect of combining four stimulation methods with SSRI in treating depression was better than that of SSRI alone(P<0.05).Probability sorting results showed that low-frequency stimulated bilateral DLPFC(88.9%)>low-frequency stimulated l-DLPFC(63.1%)>high-frequency stimulation l-DLPFC(57.1%)>low-frequency stimulation r-DLPFC(40.4%).There was no statistically significant difference in the incidence of adverse reactions between the four stimulation methods combined with SSRI and the use of SSRI alone(P>0.05).Conclusion rTMS combined with SSRIs is better than SSRIs alone in improving depressed mood after stroke.Lowfrequency rTMS stimulation of bilateral DLPFC may be the best.Meanwhile,the safety of different stimulation methods is good.