低频重复经颅磁刺激治疗重性抑郁障碍有效性和安全性的系统评价

目的系统评价低频重复经颅磁刺激(低频rTMS)治疗重性抑郁障碍的效果。方法计算机检索Cochrane图书馆、MEDLINE、EMbase、CBMdisk、CNKI、VIP等数据库,收集1985～2011年国内外关于低频rTMS作用于右侧额叶背外侧皮质治疗重性抑郁障碍的随机对照试验(RCT)。由两位研究者独立提取资料和评价纳入研究质量后,采用RevMan 4.2软件进行Meta分析。结果共纳入7个随机双盲对照试验,包括234例重性抑郁障碍患者。质量评价结果显示,7个研究中A级1个,B级5个,C级1个。Meta分析结果显示:治疗2周后,低频rTMS组的临床治愈率显著高于假刺激组[RR=3.11,95%CI(1.56,6.19)],而HDRS评分和MADRS评分则显著低于假刺激组[WMD=–6.41,95%CI(–9.32,–3.50);WMD=–5.27,95%CI(–9.08,–1.46)],但有效性与假刺激组无显著差异[RR=1.72,95%CI(0.74,4.01)]。7个纳入研究均未报道任何严重、不可耐受的不良反应。结论低频rTMS是一种无创、安全的治疗技术,可提高重度抑郁障碍患者的临床治愈率,降低抑郁量表评分,但有效率与假刺激组无显著差异。建议进行重性抑郁障碍治疗时,rTMS的参数选择:频率为1Hz,强度为运动阈值的90%～110%,作用位置右侧额叶背外侧区,治疗周期2周。但在将其应用到临床一线治疗之前,仍需开展更多大样本多中心的高质量研究。

Low Frequency Repetitive Transcranial Magnetic Stimulation (rTMS) for Major Depressive Disorder: A Systematic Review

Objective To systematically review the efficacy of low-frequency repetitive transcranial magnetic stimulation(rTMS) compared with sham therapy for the treatment of major depressive disorder.Methods The Cochrane Library,Medline,EMbase,CBMdisk,CNKI and VIP were searched through computer from 1985 to 2011.The review included RCTs comparing the treatment efficacy of low-frequency rTMS located on right dorsolateral prefrontal cortex(DLPFC) with sham stimulation in the patients suffering major depressive disorder...