低频重复经颅磁刺激治疗卒中后抑郁疗效的Meta分析
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摘要
目的:系统评价低频重复经颅磁刺激(rTMS)治疗卒中后抑郁(PSD)的疗效。方法:计算机检索Cochrane Library、Medline、Embase、中国生物医学文献数据库(CBM),搜索有关低频rTMS治疗PSD的随机对照试验(RCTs),检索时限为建库到2017年10月。收集2005年1月～2017年10月间的相关文献,对纳入研究的文献资料采用RevMan 5.1软件进行Meta分析。结果:2005年1月～2017年10月间的相关文献符合标准的有21项RCTs,1 626例PSD患者。Meta分析结果表明:①与使用抗抑郁药组比较,0.5 Hz和1 Hz rTMS组治疗后的汉密尔顿抑郁量表(HAMD)分数降低更明显[0.5 Hz:[SMD=-0.95,95%CI(-1.19,-0.70), P<0.000 01];1 Hz:[SMD=-0.44,95%CI(-0.66,-0.23), P<0.000 1]];与空白对照组比较,0.5 Hz和1 Hz rTMS组治疗后的HAMD分数降低差异有统计学意义[0.5 Hz:[SMD=-1.35,95%CI(-1.70,-1.01),P<0.000 01];1 Hz:[SMD=-1.03,95%CI(-1.39,-0.67), P<0.000 01]]。②低频rTMS组治疗后的Barthel指数、简易精神状态检查表(MMSE)评分较对照组升高明显[Barthel指数:[SMD=1.38,95%CI(0.87, 1.89), P<0.000 01];MMSE:[SMD=0.60, 95%CI(0.31, 0.90), P<0.000 1]]。③两组治疗前后美国国立卫生院神经功能缺损评分(NIHSS)变化差异无统计学意义;④低频rTMS组会出现头痛等不良反应。结论:低频rTMS可以明显改善PSD患者的抑郁情绪,提高PSD患者的日常生活能力,改善患者的认知功能,而对于NIHSS评分改善证据尚不充分,并且可能会出现症状比较轻微并发症如头痛等,故需要进行高质量的临床研究验证。
Objective To systematically assess the therapeutic efficacy of low-frequency repetitive transcranial magnetic stimulation(rTMS) in post-stroke depression(PSD). Methods The randomized controlled trials on low-frequency r TMS for post-stroke depression were retrieved from several databases, including Cochrane Library, Medline, Embase and China Biology Medicine disc(CBM), and the retrieve time range was from the establishment to October 2017. The relevant literatures from January 2005 to October 2017 were collected, and Rev Man 5.1 software was used to perform Meta-analysis on the literatures included in the study. Results Among the relevant literatures from January 2005 to October 2017, a total of 21 randomized controlled trials which included 1 626 PSD patients met the criteria. The results of Meta-analysis showed that compared with those of antidepressant group, the Hamilton depression rating scale(HAMD) score of r TMS groups(0.5 Hz and 1 Hz) decreased more obviously[0.5 Hz:[SMD=-0.95, 95%CI(-1.19,-0.70), P<0.000 01]; 1 Hz:[SMD=-0.44, 95%CI(-0.66,-0.23), P<0.000 1]]; and that the HAMD scores of rTMS groups(0.5 Hz and 1 Hz) were significantly lower than those of control group, with statistical significance[0.5 Hz:[SMD=-1.35, 95%CI(-1.70,-1.01), P<0.000 01]; 1 Hz:[SMD=-1.03, 95%CI(-1.39,-0.67), P<0.000 01]].The barthel index and minimum mental state examination(MMSE) score in r TMS group were superior to those in control group[Barthel index:[SMD=1.38, 95%CI(0.87, 1.89), P<0.000 01]; MMSE:[SMD=0.60, 95%CI(0.31, 0.90), P<0.000 1]]. There was no significant difference in national institute of health stroke scale(NIHSS) score between the two groups after treatment.In addition, the patients in rTMS group had adverse reactions, such as headache. Conclusion Low-frequency r TMS can significantly alleviate the depression of PSD patients, improve their daily living abilities, and enhance their cognitive functions.However, there is insufficient evidence for the improvement of NIHSS score with low-frequency r TMS. Moreover, PSD patient treated with low-frequency rTMS may have mild complications such as headache. Therefore, a high-quality clinical research validation is required.
Objective To systematically assess the therapeutic efficacy of low-frequency repetitive transcranial magnetic stimulation(rTMS) in post-stroke depression(PSD). Methods The randomized controlled trials on low-frequency r TMS for post-stroke depression were retrieved from several databases, including Cochrane Library, Medline, Embase and China Biology Medicine disc(CBM), and the retrieve time range was from the establishment to October 2017. The relevant literatures from January 2005 to October 2017 were collected, and Rev Man 5.1 software was used to perform Meta-analysis on the literatures included in the study. Results Among the relevant literatures from January 2005 to October 2017, a total of 21 randomized controlled trials which included 1 626 PSD patients met the criteria. The results of Meta-analysis showed that compared with those of antidepressant group, the Hamilton depression rating scale(HAMD) score of r TMS groups(0.5 Hz and 1 Hz) decreased more obviously[0.5 Hz:[SMD=-0.95, 95%CI(-1.19,-0.70), P<0.000 01]; 1 Hz:[SMD=-0.44, 95%CI(-0.66,-0.23), P<0.000 1]]; and that the HAMD scores of rTMS groups(0.5 Hz and 1 Hz) were significantly lower than those of control group, with statistical significance[0.5 Hz:[SMD=-1.35, 95%CI(-1.70,-1.01), P<0.000 01]; 1 Hz:[SMD=-1.03, 95%CI(-1.39,-0.67), P<0.000 01]].The barthel index and minimum mental state examination(MMSE) score in r TMS group were superior to those in control group[Barthel index:[SMD=1.38, 95%CI(0.87, 1.89), P<0.000 01]; MMSE:[SMD=0.60, 95%CI(0.31, 0.90), P<0.000 1]]. There was no significant difference in national institute of health stroke scale(NIHSS) score between the two groups after treatment.In addition, the patients in rTMS group had adverse reactions, such as headache. Conclusion Low-frequency r TMS can significantly alleviate the depression of PSD patients, improve their daily living abilities, and enhance their cognitive functions.However, there is insufficient evidence for the improvement of NIHSS score with low-frequency r TMS. Moreover, PSD patient treated with low-frequency rTMS may have mild complications such as headache. Therefore, a high-quality clinical research validation is required.
引文
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[2]SANTOS E B,PONTESNETO O M.Prevalence and predictors of post stroke depression among elderly stroke survivors[J].Arq Neuropsiquiatr,2016,74(8):621-625.
[3]KIM K U,IM S H,AN T G.The effects of repetitive transcranial magnetic stimulation(rTMS)on depression,visual perception,and activities of daily living in stroke patients[J].J Phys Ther Sci,2017,29(6):1036-1039.
[4]CHEN Y P,MEI Y W,SUN G,et al.Evaluation of frequency repetitive transcranial magnetic stimulation for post-stroke depression and neurologic impairment[J].Chin J Clin Rehabil,2005,9(20):18-19.
[5]DU D Q,WU Y B.Living ability and cognitive function ameliorated by low frequency repetitive transcranial magnetic stimulation in patients with post-stroke depression:comparison with drug plus psychological treatment[J].Chin J Clin Rehabil,2005,9(16):22-23.
[6]严婷婷,何明利,顾正天.高频及低频重复经颅磁刺激对脑卒中后抑郁的疗效对比研究[J].青岛医药卫生,2010,42(2):81-85.YAN T T,HE M L,GU Z T.Comparative study of high-frequency and low-frequency repetitive transcranial magnetic stimulation on poststroke depression[J].Qingdao Medical Journal,2010,42(2):81-85.
[7]刘景,王威.重复经颅磁刺激结合针刺治疗卒中后抑郁症39例疗效观察[J].河北中医,2010,32(11):1688-1690.LIU J,WANG W.Clinical observation of 39 cases of post-stroke depression treated with repetitive transcranial magnetic stimulation combined with acupuncture[J].Hebei Journal of Traditional Chinese Medicine,2010,32(11):1688-1690.
[8]孙佳,王红,宋清扬,等.重复经颅磁刺激治疗卒中后抑郁的疗效[J].中西医结合心脑血管病杂志,2013,11(3):321-322.SUN J,WANG H,SONG Q Y,et al.The efficacy of repeated transcranial magnetic stimulation in the treatment of post-stroke depression[J].Journal of Integrated Traditional and Western Medicine on Cardiovascular and Cerebrovascular Diseases,2013,11(3):321-322.
[9]张改革.低频重复经颅磁刺激辅治卒中后抑郁症的疗效观察[J].临床合理用药杂志,2014,7(19):134.ZHANG G G.Observation of the efficacy of low frequency repetitive transcranial magnetic stimulation in the treatment of post-stroke depression[J].Chinese Journal of Clinical Rational Drug Use,2014,7(19):134.
[10]李克娇.低频重复经颅磁刺激治疗对卒中后抑郁患者认知和日常生活能力的影响[J].神经损伤与功能重建,2015,10(5):411-413.LI K J.Effect of low frequency repetitive transcranial magnetic stimulation on cognitive and daily living ability in patients with poststroke depression[J].Nerve Injury and Functional Reconstruction,2015,10(5):411-413.
[11]李凡,姚黎清.重复经颅磁刺激联合氟西汀对卒中后抑郁的临床疗效研究[J].临床精神医学杂志,2017,27(2):144.LI F,YAO L Q.Clinical efficacy of repetitive transcranial magnetic stimulation combined with fluoxetine in post-stroke depression[J].Journal of Clinical Psychiatry,2017,27(2):144.
[12]李宁,韩嫣,潘伟盟,等.米氮平合并重复经颅磁刺激治疗脑卒中后抑郁的疗效研究[J].中国伤残医学,2013,21(6):48-50.LI N,HAN Y,PAN W M,et al.Therapeutic effect of mirtazapine combined with repetitive transcranial magnetic stimulation on poststroke depression[J].Chinese Journal of Trauma and Disability Medicine,2013,21(6):48-50.
[13]杨柳,刘玉山,刘兰祥,等.不同频率重复经颅磁刺激治疗脑卒中后抑郁障碍的疗效观察[J].中国实用神经疾病杂志,2014,17(22):18-20.YANG L,LIU Y S,LIU L X,et al.Therapeutic effect of transcranial magnetic stimulation with different frequencies on post-stroke depression[J].Chinese Journal of Practical Nervous Diseases,2014,17(22):18-20.
[14]潘红珊,莫翠英,叶杏萍.艾灸联合艾司西酞普兰以及经颅磁刺激(r TMS)治疗脑卒中后抑郁的临床观察[J].内蒙古中医药,2017,36(10):116-117.PAN H S,MO C Y,YE X P.Clinical observation of moxibustion combined with escitalopram and transcranial magnetic stimulation(r TMS)in the treatment of post-stroke depression[J].Inner Mongolia Journal of Traditional Chinese Medicine,2017,36(10):116-117.
[15]王培芝,王巍,徐维维,等.低频重复经颅磁刺激治疗脑卒中后抑郁疗效观察[J].河北医药,2008,30(9):1346-1347.WANG P Z,WANG W,XU W W,et al.Therapeutic effect of low frequency repetitive transcranial magnetic stimulation on post-stroke depression[J].Hebei Medical Journal,2008,30(9):1346-1347.
[16]王培芝,王翠平,王巍,等.磁刺激治疗脑卒中后抑郁对神经功能康复的影响[J].护理研究,2009,23(15):1356-1357.WANG P Z,WANG C P,WANG W,et al.Effects of magnetic stimulation on post-stroke depression on neurological rehabilitation[J].Journal of Nursing Research,2009,23(15):1356-1357.
[17]王韵喃,杨轩,万赛英.低频重复经颅磁刺激改善脑卒中抑郁患者生活能力和认知功能观察[J].现代中西医结合杂志,2014,23(21):2311-2313.WANG Y N,YANG X,WAN S Y.Low-frequency repetitive transcranial magnetic stimulation to improve the ability of life and cognitive function in patients with stroke depression[J].Modern Journal of Integrated Traditional Chinese and Western Medicine,2014,23(21):2311-2313.
[18]田锦芳,贾会荣.重复经颅磁刺激对脑卒中后抑郁患者功能恢复的影响[J].中华物理医学与康复杂志,2010,32(6):457-458.TIAN J F,JIA H R.Effects of repetitive transcranial magnetic stimulation on functional recovery in patients with post-stroke depression[J].Chinese Journal of Physical Medicine and Rehabilitation,2010,32(6):457-458.
[19]程素满,陈金峰.氟西汀联合经颅磁刺激治疗脑卒中后抑郁的疗效研究[J].中国康复医学杂志,2011,26(10):980-981.CHENG S M,CHEN J F.Therapeutic effect of fluoxetine combined with transcranial magnetic stimulation on post-stroke depression[J].Chinese Journal of Rehabilitation Medicine,2011,26(10):980-981.
[20]范小艳.度洛西丁联合重复经颅磁刺激治疗脑卒中后抑郁的效果[J].中国实用神经疾病杂志,2014,17(9):102-103.FAN X Y.Effect of duloxetine combined with repetitive transcranial magnetic stimulation on post-stroke depression[J].Chinese Journal of Practical Nervous Diseases,2014,17(9):102-103.
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