低頻重復經顱磁刺激治療重性抑郁障礙有效性和安全性的系統評價_《中國循證醫學雜志》

作者：

藺俊斌 ¹ ,  廖維靖 ¹ , 王樸 ¹ , 李華鋼 ² , 郭毅 ^3,4

1. 武漢大學中南醫院康復醫學科（武漢?430071）；2. 武漢大學中南醫院神經內科（武漢?430071）；3. 武漢大學公共衛生學院流行病學教研室（武漢?430071）；4. 武漢大學病毒學重點實驗室（武漢?430071）;

關鍵詞：

低頻重復經顱磁刺激重性抑郁障礙隨機對照試驗系統評價 Meta分析

DOI：

10.7507/1672-2531.20110200

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目的　系統評價低頻重復經顱磁刺激（低頻rTMS）治療重性抑郁障礙的效果。
方法　計算機檢索Cochrane圖書館、MEDLINE、EMbase、CBMdisk、CNKI、VIP等數據庫，收集1985～2011年國內外關于低頻rTMS作用于右側額葉背外側皮質治療重性抑郁障礙的隨機對照試驗（RCT）。由兩位研究者獨立提取資料和評價納入研究質量后，采用RevMan 4.2軟件進行Meta分析。
結果　共納入7個隨機雙盲對照試驗，包括234例重性抑郁障礙患者。質量評價結果顯示，7個研究中A級1個，B級5個，C級1個。Meta分析結果顯示：治療2周后，低頻rTMS組的臨床治愈率顯著高于假刺激組［RR=3.11，95%CI（1.56，6.19）］，而HDRS評分和MADRS評分則顯著低于假刺激組［WMD= –6.41，95%CI（–9.32，–3.50）；WMD= –5.27，95%CI（–9.08，–1.46）］，但有效性與假刺激組無顯著差異［RR=1.72，95%CI（0.74，4.01）］。7個納入研究均未報道任何嚴重、不可耐受的不良反應。
結論　低頻rTMS是一種無創、安全的治療技術，可提高重度抑郁障礙患者的臨床治愈率，降低抑郁量表評分，但有效率與假刺激組無顯著差異。建議進行重性抑郁障礙治療時，rTMS的參數選擇：頻率為1Hz，強度為運動閾值的90%～110%，作用位置右側額葉背外側區，治療周期2周。但在將其應用到臨床一線治療之前，仍需開展更多大樣本多中心的高質量研究。

引用本文： 藺俊斌,廖維靖,王樸,李華鋼,郭毅. 低頻重復經顱磁刺激治療重性抑郁障礙有效性和安全性的系統評價. 中國循證醫學雜志, 2011, 11(10): 1192-1198. doi: 10.7507/1672-2531.20110200 復制

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2.	Stewart WF, Ricci JA, Chee E, et al . Cost of lost productive work time among US workers with depression. JAMA , 2003, 289(23): 3135-3144.
3.	Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet , 1997, 349(9064): 1498-1504.
4.	王玉鋒, 后宮林. 抑郁癥的近代藥物治療. 第四軍醫大學學報, 2006, 27(16): 1526-1528.
5.	王繼軍, 江開達, 徐一峰. 經顱磁刺激治療抑郁癥的機制和臨床應用現狀. 上海精神醫學, 2008, 20(1): 49-52.
6.	Benac N. United States reviews safety of electroconvulsive therapy. CMAJ , 2011, 183(5): E269- E270.
7.	Barker AT, Jalinous R, Freeston IL. Non-invasive magnetic stimulation of human motor cortex. Lancet , 1985, 1(8437): 1106-1107.
8.	Wassermann EM, Lisanby SH. Therapeutic application of repetitive transcranial magnetic stimulation: a review. Clin Neurophysiol , 2001, 112(8): 1367-1377.
9.	Pascual-Leone A, Valls-Sole J, Wassermann EM, et al . Responses to rapid-rate transcranial magnetic stimulation of the human motor cortex. Brain , 1994, 117 (Pt 4): 847-858.
10.	Chen R, Classen J, Gerloff C, et al . Depression of motor cortex excitability by low-frequency transcranial magnetic stimulation. Neurology , 1997, 48(5): 1398-1403.
11.	陳進, 倪朝民. 重復經顱磁刺激及其在抑郁癥康復中的應用進展. 安徽醫學, 2010, 31(2): 173-177.
12.	Schutter DJ. Antidepressant efficacy of high-frequency transcranial magnetic stimulation over the left dorsolateral prefrontal cortex in double-blind sham-controlled designs: a meta-analysis. Psychol Med , 2009, 39(1): 65-75.
13.	American Psychiatric Association. Diagnostic and Manual of Mental Disorder. 4th edition. American Psychiatric Press: Washington DC, 1994.
14.	Kauffmann CD, Cheema MA, Miller BE. Slow right prefrontal transcranial magnetic stimulation as a treatment for medication-resistant depression: a double-blind, placebo-controlled study. Depress Anxiety , 2004, 19(1): 59-62.
15.	Klein E, Kreinin I, Chistyakov A, et al . Therapeutic efficacy of right prefrontal slow repetitive transcranial magnetic stimulation in major depression: a double-blind controlled study. Arch Gen Psychiatry , 1999, 56(4): 315-320.
16.	Fitzgerald PB, Brown TL, Marston NA, et al . Transcranial magnetic stimulation in the treatment of depression: a double-blind, placebo-controlled trial. Arch Gen Psychiatry , 2003, 60(10): 1002-1008.
17.	Hoppner J, Schulz M, Irmisch G, et al . Antidepressant efficacy of two different rTMS procedures. High frequency over left versus low frequency over right prefrontal cortex compared with sham stimulation. Eur Arch Psychiatry Clin Neurosci , 2003, 253(2): 103-109.
18.	Januel D, Dumortier G, Verdon CM, et al . A double-blind sham controlled study of right prefrontal repetitive transcranial magnetic stimulation (rTMS): therapeutic and cognitive effect in medication free unipolar depression during 4 weeks. Prog Neuropsychopharmacol Biol Psychiatry , 2006, 30(1): 126-130.
19.	Stern WM, Tormos JM, Press DZ, et al . Antidepressant effects of high and low frequency repetitive transcranial magnetic stimulation to the dorsolateral prefrontal cortex: a double-blind, randomized, placebo-controlled trial. J Neuropsychiatry Clin Neurosci , 2007, 19(2): 179-186.
20.	Pallanti S, Bernardi S, Di Rollo A, et al . Unilateral low frequency versus sequential bilateral repetitive transcranial magnetic stimulation: is simpler better for treatment of resistant depression? Neuroscience , 2010, 167(2): 323-328.
21.	Martin JL, Barbanoj MJ, Schlaepfer TE, et al . Repetitive transcranial magnetic stimulation for the treatment of depression. Systematic review and meta-analysis. Br J Psychiatry , 2003, 182: 480-491.
22.	Couturier JL. Efficacy of rapid-rate repetitive transcranial magnetic stimulation in the treatment of depression: a systematic review and meta-analysis. J Psychiatry Neurosci , 2005, 30(2): 83-90.
23.	Lam RW, Chan P, Wilkins-Ho M, et al . Repetitive transcranial magnetic stimulation for treatment-resistant depression: a systematic review and metaanalysis. Can J Psychiatry , 2008, 53(9): 621-631.
24.	Machii K, Cohen D, Ramos-Estebanez C, et al . Safety of rTMS to non-motor cortical areas in healthy participants and patients. Clin Neurophysiol , 2006, 117(2): 455-471.

1. 1 Andrade L, Caraveo-Anduaga JJ, Berglund P, et al . The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. Int J Methods Psychiatr Res , 2003, 12(1): 3-21.
2. Stewart WF, Ricci JA, Chee E, et al . Cost of lost productive work time among US workers with depression. JAMA , 2003, 289(23): 3135-3144.
3. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet , 1997, 349(9064): 1498-1504.
4. 王玉鋒, 后宮林. 抑郁癥的近代藥物治療. 第四軍醫大學學報, 2006, 27(16): 1526-1528.
5. 王繼軍, 江開達, 徐一峰. 經顱磁刺激治療抑郁癥的機制和臨床應用現狀. 上海精神醫學, 2008, 20(1): 49-52.
6. Benac N. United States reviews safety of electroconvulsive therapy. CMAJ , 2011, 183(5): E269- E270.
7. Barker AT, Jalinous R, Freeston IL. Non-invasive magnetic stimulation of human motor cortex. Lancet , 1985, 1(8437): 1106-1107.
8. Wassermann EM, Lisanby SH. Therapeutic application of repetitive transcranial magnetic stimulation: a review. Clin Neurophysiol , 2001, 112(8): 1367-1377.
9. Pascual-Leone A, Valls-Sole J, Wassermann EM, et al . Responses to rapid-rate transcranial magnetic stimulation of the human motor cortex. Brain , 1994, 117 (Pt 4): 847-858.
10. Chen R, Classen J, Gerloff C, et al . Depression of motor cortex excitability by low-frequency transcranial magnetic stimulation. Neurology , 1997, 48(5): 1398-1403.
11. 陳進, 倪朝民. 重復經顱磁刺激及其在抑郁癥康復中的應用進展. 安徽醫學, 2010, 31(2): 173-177.
12. Schutter DJ. Antidepressant efficacy of high-frequency transcranial magnetic stimulation over the left dorsolateral prefrontal cortex in double-blind sham-controlled designs: a meta-analysis. Psychol Med , 2009, 39(1): 65-75.
13. American Psychiatric Association. Diagnostic and Manual of Mental Disorder. 4th edition. American Psychiatric Press: Washington DC, 1994.
14. Kauffmann CD, Cheema MA, Miller BE. Slow right prefrontal transcranial magnetic stimulation as a treatment for medication-resistant depression: a double-blind, placebo-controlled study. Depress Anxiety , 2004, 19(1): 59-62.
15. Klein E, Kreinin I, Chistyakov A, et al . Therapeutic efficacy of right prefrontal slow repetitive transcranial magnetic stimulation in major depression: a double-blind controlled study. Arch Gen Psychiatry , 1999, 56(4): 315-320.
16. Fitzgerald PB, Brown TL, Marston NA, et al . Transcranial magnetic stimulation in the treatment of depression: a double-blind, placebo-controlled trial. Arch Gen Psychiatry , 2003, 60(10): 1002-1008.
17. Hoppner J, Schulz M, Irmisch G, et al . Antidepressant efficacy of two different rTMS procedures. High frequency over left versus low frequency over right prefrontal cortex compared with sham stimulation. Eur Arch Psychiatry Clin Neurosci , 2003, 253(2): 103-109.
18. Januel D, Dumortier G, Verdon CM, et al . A double-blind sham controlled study of right prefrontal repetitive transcranial magnetic stimulation (rTMS): therapeutic and cognitive effect in medication free unipolar depression during 4 weeks. Prog Neuropsychopharmacol Biol Psychiatry , 2006, 30(1): 126-130.
19. Stern WM, Tormos JM, Press DZ, et al . Antidepressant effects of high and low frequency repetitive transcranial magnetic stimulation to the dorsolateral prefrontal cortex: a double-blind, randomized, placebo-controlled trial. J Neuropsychiatry Clin Neurosci , 2007, 19(2): 179-186.
20. Pallanti S, Bernardi S, Di Rollo A, et al . Unilateral low frequency versus sequential bilateral repetitive transcranial magnetic stimulation: is simpler better for treatment of resistant depression? Neuroscience , 2010, 167(2): 323-328.
21. Martin JL, Barbanoj MJ, Schlaepfer TE, et al . Repetitive transcranial magnetic stimulation for the treatment of depression. Systematic review and meta-analysis. Br J Psychiatry , 2003, 182: 480-491.
22. Couturier JL. Efficacy of rapid-rate repetitive transcranial magnetic stimulation in the treatment of depression: a systematic review and meta-analysis. J Psychiatry Neurosci , 2005, 30(2): 83-90.
23. Lam RW, Chan P, Wilkins-Ho M, et al . Repetitive transcranial magnetic stimulation for treatment-resistant depression: a systematic review and metaanalysis. Can J Psychiatry , 2008, 53(9): 621-631.
24. Machii K, Cohen D, Ramos-Estebanez C, et al . Safety of rTMS to non-motor cortical areas in healthy participants and patients. Clin Neurophysiol , 2006, 117(2): 455-471.

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《中國循證醫學雜志》

低頻重復經顱磁刺激治療重性抑郁障礙有效性和安全性的系統評價

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