高频重复经颅磁刺激治疗脑卒中后抑郁的Meta分析

A Meta-analysis of high-frequency repetitive transcranial magnetic stimulation in the treatment of post-stroke depression

目的:脑卒中后抑郁(Post-stroke Depression,PSD)常发生于脑卒中患者,PSD患者的身体恢复较差、日常生活活动减少且自我效能降低,严重影响康复进程。重复经颅磁刺激(Repeat Transcranial Magnetic Stimulation,rTMS)可用来诱导人类大脑皮质的可塑性,并已显示出治疗抑郁症的前景。本研究系统评价高频重复经颅磁刺激(High-frequency Repetitive Transcranial Magnetic Stimulation,HF-rTMS)治疗PSD患者的疗效。方法:检索Pub Med、Embase、Cochrane Library、Web of Science、中国知网、万方、维普和中国生物医学文献数据库(CBM)共8个数据库,时间为各数据库建立至2023年2月14日,文献类型为随机对照试验,内容为HF-rTMS(频率≥10 Hz)治疗PSD。由两位作者独立筛选符合纳入和排除标准的研究,提取资料,并使用Cochrane偏倚风险工具评估纳入研究的质量,最后使用Rev Man 5.4和Stata 17.0软件提取数据进行Meta分析。结果:最终纳入8篇文献,542例PSD患者,Meta分析结果显示:HF-rTMS较控制组能够明显降低PSD患者的汉密尔顿抑郁量表评分[均数差(MD)=–2.72,95%置信区间(CI)(–3.28,–2.15),P<0.00001],且能更好地改善PSD患者神经功能缺损症状[MD=–3.31,95%CI(–4.11,–2.50),P<0.00001]。结论:当前的临床证据表明,HF-rTMS治疗可以有效地改善脑卒中患者的抑郁症状和日常生活活动能力,且安全性、耐受性良好,但受纳入研究数量和质量的限制,上述结论尚需更多高质量研究予以验证。

Objective:Post-stroke depression(PSD)often occurs in stroke patients.The physical recovery of patients with PSD is poor,the activities of daily living are reduced,and the self-efficacy is reduced,which seriously affects the rehabilitation process.Repeat transcranial magnetic stimulation(rTMS)can be used to induce plasticity in the human cerebral cortex and has shown promise for the treatment of depression.This article evaluates systematically the efficacy of high-frequency repetitive transcranial magnetic stimulation(HF-rTMS)in the treatment of patients with PSD.Methods:Eight databases including PubMed,Embase,Cochrane Library,Web of Science,CNKI,Wanfang,VIP and CBM were searched from the establishment of the databases to February 14,2023.The literature type was randomized controlled trial(RCT),and the content was HF-rTMS(frequency≥10 Hz)for poststroke depression.Two authors independently screened for studies that met the inclusion and exclusion criteria,extracted data,and assessed the quality of included studies using the Cochrane bias risk tool.Finally,data was extracted using RevMan 5.4 and Stata 17.0 software for a Meta-analysis.Results:Finally,8 literatures were included,including 542 patients with PSD,and the results of Meta-analysis showed that compared with the control group,HF-rTMS could significantly reduce the Hamilton depression score of PSD patients[MD=-2.72,95%CI(-3.28,-2.15),P<0.00001].Moreover,it could better relieve the symptoms of neurological impairment in PSD patients[MD=-3.31,95%CI(-4.11,-2.50),P<0.00001].Conclusion:Current clinical evidence shows that HF-rTMS therapy can effectively relieve depression symptoms and improve the activities of daily living in stroke patients,and is safe,with well tolerated.Limited by the number and quality of included studies,the above conclusions need to be verified by more high-quality studies.