神经调节疗法治疗难治性抑郁症的疗效及可接受性比较：一项随机对照试验的网状Meta分析
Comparative efficacy and acceptability of neuromodulation procedures in the treatment of treatment-resistant depression: a network meta-analysis of randomized controlled trials.
作者信息
Li Hao, Cui Liqian, Li Jinbiao, Liu Yueheng, Chen Yue
机构信息
Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080, China.
Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080, China.
出版信息
J Affect Disord. 2021 May 15;287:115-124. doi: 10.1016/j.jad.2021.03.019. Epub 2021 Mar 11.
BACKGROUND
Nearly half of the patients with depression experience suboptimal benefits from antidepressants. Neuromodulation therapies, a kind of technology that can regulate neuronal firing activity by electrical or magnetic stimulation, were introduced to improve this situation. However, the results from clinical trials have been inconsistent.
METHODS
We followed the extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to perform this network meta-analysis (NMA). The results were evaluated by relative risk (RR) for the response, remission, and discontinuation rates.
RESULTS
In total, 49 trials with 2,941 patients were included in this study. Bilateral theta burst stimulation (TBS, RR 5.00, 95% CI 1.11-22.44), priming transcranial magnetic stimulation (pTMS, RR 2.97, 95% CI 1.20-7.39), low-frequency right repetitive transcranial magnetic stimulation (TMS) (LFR-rTMS, RR 2.62, 95% CI 1.56-4.39), high-frequency left repetitive TMS (HFL-rTMS, RR 2.18, 95% CI 1.52-3.13), and bilateral repetitive TMS (BL-rTMS, RR 3.08, 95% CI 1.78-5.31) were demonstrated to have higher response rates than sham control. BL-rTMS (RR 3.12, 95% CI 1.06-9.09) was found to have a higher response rate than deep brain stimulation in this NMA. All measures had the non-inferiority acceptability than the sham-control. BL-rTMS was more acceptable than bitemporal ECT (BT-ECT, RR 0.18, 95% CI 0.03-0.89), while pTMS was more acceptable than BT-ECT (RR 0.08, 95% CI 0.01-0.55), HFL-rTMS (RR 0.34, 95% CI 0.12-0.93), and deep TMS (RR 0.15, 95% CI 0.02-0.96).
CONCLUSION
Besides electroconvulsive therapy (ECT), rTMS, priming TMS, and bilateral TBS proved effective for patients with treatment-resistant depression (TRD). BL-rTMS showed high efficacy and acceptability, and bilateral TBS had the potential to be the most efficacious neuromodulation measures.
背景
近一半的抑郁症患者对抗抑郁药的疗效欠佳。神经调节疗法作为一种可通过电刺激或磁刺激来调节神经元放电活动的技术，被引入以改善这种状况。然而，临床试验的结果并不一致。
方法
我们遵循系统评价和Meta分析的首选报告项目（PRISMA）声明的扩展版来进行这项网状Meta分析（NMA）。通过相对危险度（RR）对缓解率、治愈率和停药率进行结果评估。
结果
本研究共纳入49项试验，涉及2941例患者。双侧theta爆发刺激（TBS，RR 5.00，95%CI 1.11 - 22.44）、启动式经颅磁刺激（pTMS，RR 2.97，95%CI 1.20 - 7.39）、低频右侧重复经颅磁刺激（LFR - rTMS，RR 2.62，95%CI 1.56 - 4.39）、高频左侧重复经颅磁刺激（HFL - rTMS，RR 2.18，95%CI 1.52 - 3.13）和双侧重复经颅磁刺激（BL - rTMS，RR 3.08，95%CI 1.78 - 5.31）的缓解率均高于假对照。在此网状Meta分析中，发现BL - rTMS（RR 3.12，95%CI 1.06 - 9.09）的缓解率高于深部脑刺激。所有措施与假对照相比均具有非劣效性可接受性。BL - rTMS比双侧颞叶电休克疗法（BT - ECT，RR 0.18，95%CI 0.03 - 0.89）更具可接受性，而pTMS比BT - ECT（RR 0.08，95%CI 0.01 - 0.55）、HFL - rTMS（RR 0.34，95%CI 0.12 - 0.93）和深部经颅磁刺激（RR 0.15，95%CI 0.02 - 0.96）更具可接受性。
结论
除电休克疗法（ECT）外，重复经颅磁刺激（rTMS）、启动式TMS和双侧TBS对难治性抑郁症（TRD）患者有效。BL - rTMS显示出高疗效和可接受性，双侧TBS有可能成为最有效的神经调节措施。
Zotero 插件