Wu Youliang, Mo Jiajie, Sui Lisen, Zhang Jianguo, Hu Wenhan, Zhang Chao, Wang Yao, Liu Chang, Zhao Baotian, Wang Xiu, Zhang Kai, Xie Xuemin
Department of Functional Neurosurgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Front Neurosci. 2021 Apr 1;15:655412. doi: 10.3389/fnins.2021.655412. eCollection 2021.
Deep brain stimulation (DBS) has shown promising outcomes as new therapeutic opportunities for patients with treatment-resistant depression (TRD) who do not respond adequately to several consecutive treatments. This study aims to systematically review and conduct a meta-analysis on the efficacy and safety of DBS for TRD. The literature was comprehensively reviewed using Medline, Google scholar, Cochrane library, Embase, and World Health Organization International Clinical Trials Registry Platform until January 2019. The studied outcomes included response, remission, recurrence, and adverse events (AEs) rates, and were reported as the rate ratio (RR) or pooled estimate with a 95% confidence interval (95% CI). Heterogeneity was measured by an I-square test and a sensitive analysis. A total of 17 studies involving 7 DBS targets were included. For efficacy, DBS treatment was statistically beneficial for TRD, and the response, remission, and recurrence rates were 56% (ranging from 43 to 69%), 35% (ranging from 27 to 44%), and 14% (ranging from 4 to 25%), respectively. However, only two randomized-controlled trials (RCTs) considered the invalidity of DBS ( = 1.45, 95% CI = 0.50-4.21). For safety, the AEs rate was 67% (ranging from 54 to 80%). The AEs were common and moderate, but the problems related to suicide and suicidal ideation should not be underestimated. These findings suggest that DBS for TRD is considered promising, which should be confirmed by well-designed and large sample studies. Future basic research and comprehensive clinical trials are needed to reach better understanding on the mechanisms of action and optimal targeted structure.
对于那些对连续多次治疗反应不佳的难治性抑郁症（TRD）患者而言，深部脑刺激（DBS）作为一种新的治疗手段已展现出了令人期待的效果。本研究旨在对DBS治疗TRD的疗效和安全性进行系统评价并开展荟萃分析。截至2019年1月，通过检索Medline、谷歌学术、考克兰图书馆、Embase以及世界卫生组织国际临床试验注册平台对相关文献进行了全面回顾。研究的结局指标包括缓解率、治愈率、复发率以及不良事件（AE）发生率，并以率比（RR）或合并估计值及95%置信区间（95%CI）进行报告。采用I²检验和敏感性分析来衡量异质性。共纳入17项涉及7个DBS靶点的研究。在疗效方面，DBS治疗对TRD具有统计学意义上的益处，缓解率、治愈率和复发率分别为56%（范围43%至69%）、35%（范围27%至44%）和14%（范围4%至25%）。然而，仅有两项随机对照试验（RCT）考虑了DBS无效的情况（RR = 1.45，95%CI = 0.50 - 4.21）。在安全性方面，不良事件发生率为67%（范围54%至80%）。不良事件常见且程度为中度，但与自杀及自杀意念相关的问题不应被低估。这些研究结果表明，DBS治疗TRD被认为具有前景，但这需要通过设计良好的大样本研究来证实。未来需要开展基础研究和全面的临床试验，以更好地理解其作用机制和最佳靶点结构。
