Department of Critical Care Medicine, Beihua University Affiliated Hospital, Jilin 132011, China.
Department of Rehabilitation, Shanghai Putuo People's Hospital, Shanghai 200060, China.
Clin Neurol Neurosurg. 2020 Aug;195:105910. doi: 10.1016/j.clineuro.2020.105910. Epub 2020 May 16.
Post-stroke depression (PSD) is common consequence of stroke. However, today the majority of PSD patients remains untreated or inadequately treated, especially in the developing countries. Herein, we performed a meta-analysis to evaluate efficacy and safety of hyperbaric oxygen (HBOT) therapy for PSD.
Seven electronic databases were comprehensively searched for randomized clinical trials (RCTs) from inception to May 2019. Outcome measures included response rate, depression severity, neurological deficit, physical disability and adverse events.
A total of 27 RCTs involving 2250 participants were identified. Patients in HBOT group had a higher response rate than patients in control group (response rate: 69.4% vs 51.2%, odds ratio [OR] = 2.51, 95% confidence interval [CI] [1.83-3.43], P = 0.000). HBOT significantly reduced Hamilton Depression (HAMD) -17 item scores (weighted mean difference [WMD] = -4.33, 95% CI [-4.82 to -3.84], P = 0.000), HAMD-24 item scores (WMD = -4.31, 95% CI [-5.01 to -3.62], P = 0.000), National Institute of Health Stroke Scale (NIHSS) scores (WMD = -2.77, 95% CI [-3.57 to -1.98], P = 0.000), Chinese Stroke Scale (CSS) scores (WMD = -3.75, 95% CI [-5.12 to -2.38], P = 0.000) and Modified Scandinavian Stroke Scale (MASSS) scores (WMD = -3.66, 95% CI [-6.26 to -1.06], P = 0.000). HBOT also improved Barthel Index (WMD = 10.68, 95% CI [7.98-13.37], P = 0.000). In subgroup analysis, Group A of studies with hemorrhage patients accounting for less than 20% achieved more reduction of HAMD 17-item score (WMD = -4.47, 95% CI [-5.17 to -3.77], P = 0.000) than Group B of studies with hemorrhage patients no less than 20% (WMD = -3.73, 95% CI [-4.20 to -3.26], P = 0.000). In addition, patents with HBOT along with antidepressants treatment achieve superior results than patients with antidepressants monotherapy. Patients with HBOT monotherapy achieve a slightly higher response rate than patients with antidepressants monotherapy (OR = 1.29, 95% CI [1.04-1.60], P = 0.000). Besides, HBOT group reported less adverse events (9.6%vs16.6%, P < 0.05). The most frequent side-effect of HBOT is ear pain (26 cases).
Based on our pooled analysis, HBOT is effective and safe therapeutic approach for PSD. However, results should be cautiously interpreted due to a relatively poor methodological quality.
中风后抑郁（PSD）是中风的常见后果。然而，目前大多数 PSD 患者仍未得到治疗或治疗不足，尤其是在发展中国家。在此，我们进行了一项荟萃分析，以评估高压氧（HBOT）治疗 PSD 的疗效和安全性。
从开始到 2019 年 5 月，全面检索了七个电子数据库，以寻找随机临床试验（RCT）。结局指标包括反应率、抑郁严重程度、神经功能缺损、身体残疾和不良事件。
共纳入了 27 项 RCT，涉及 2250 名参与者。与对照组相比，HBOT 组的患者反应率更高（反应率：69.4% vs 51.2%，比值比[OR] = 2.51，95%置信区间[CI] [1.83-3.43]，P = 0.000）。HBOT 显著降低汉密尔顿抑郁量表（HAMD）-17 项评分（加权均数差 [WMD] = -4.33，95% CI [-4.82 至 -3.84]，P = 0.000）、HAMD-24 项评分（WMD = -4.31，95% CI [-5.01 至 -3.62]，P = 0.000）、国立卫生研究院卒中量表（NIHSS）评分（WMD = -2.77，95% CI [-3.57 至 -1.98]，P = 0.000）、中国卒中量表（CSS）评分（WMD = -3.75，95% CI [-5.12 至 -2.38]，P = 0.000）和改良斯堪的纳维亚卒中量表（MASSS）评分（WMD = -3.66，95% CI [-6.26 至 -1.06]，P = 0.000）。HBOT 还改善了巴氏指数（WMD = 10.68，95% CI [7.98-13.37]，P = 0.000）。亚组分析显示，出血患者占比小于 20%的 A 组研究在降低 HAMD 17 项评分方面效果更显著（WMD = -4.47，95% CI [-5.17 至 -3.77]，P = 0.000），而出血患者占比不小于 20%的 B 组研究则效果较差（WMD = -3.73，95% CI [-4.20 至 -3.26]，P = 0.000）。此外，HBOT 联合抗抑郁药治疗的患者比单独使用抗抑郁药治疗的患者疗效更优。HBOT 单一治疗的患者比单独使用抗抑郁药治疗的患者反应率略高（OR = 1.29，95% CI [1.04-1.60]，P = 0.000）。此外，HBOT 组报告的不良事件较少（9.6%vs16.6%，P < 0.05）。HBOT 最常见的副作用是耳痛（26 例）。
基于我们的汇总分析，HBOT 是 PSD 有效且安全的治疗方法。然而，由于方法学质量相对较差，结果应谨慎解释。
