重复经颅磁刺激（rTMS）引起的炎症标志物变化与精神疾病改善之间的关联：一项系统综述
Association between rTMS-induced changes in inflammatory markers and improvement in psychiatric diseases: a systematic review.
作者信息
Pedraz-Petrozzi Bruno, Insan Shrabon, Spangemacher Moritz, Reinwald Jonathan, Lamadé Eva Kathrin, Gilles Maria, Deuschle Michael, Sartorius Alexander
机构信息
Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, J5, Medical Faculty Mannheim, University of Heidelberg, 68159, Mannheim, Germany.
Research Group of Stress-related Disorders, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
出版信息
Ann Gen Psychiatry. 2024 Aug 27;23(1):31. doi: 10.1186/s12991-024-00514-0.
BACKGROUND
Repetitive transcranial magnetic stimulation (rTMS) has recently gained relevance in treating different psychiatric disorders. Limited evidence suggests that the beneficial effects of rTMS on psychopathology could be at least partly mediated through changes in inflammatory response. This systematic review summarizes the literature on whether rTMS can modulate inflammatory markers and thus positively influence the course of psychiatric illnesses.
MATERIALS AND METHODS
A systematic review of rTMS and inflammatory markers in psychiatric diseases was conducted according to PRISMA guidelines. Information on the association between rTMS treatment response and changes of inflammatory markers was extracted. The quality of the studies was assessed using the National Heart, Lung, and Blood Institute for human studies and the Systematic Review Center for Laboratory Animal Experimentation for animal studies.
RESULTS
This review includes 17 studies (2 animal and 15 human studies) on the relationship between rTMS treatment response and changes of inflammatory markers. Positive changes in microglial activity and anti-inflammatory effects were associated with behavioral improvement in animal models of depression. However, these findings have not been consistently replicated in human studies focusing on treatment-resistant depression. While several studies reported rTMS-induced alterations in peripheral inflammatory markers, only two could demonstrate their association to clinical treatment response. Notably, most studies showed poor or moderate quality in the bias assessment.
CONCLUSIONS
While certain human studies suggest an association between rTMS-induced anti-inflammatory effects and improvement in psychopathology, heterogeneity, and underpowered analyses constrain the generalizability of these results. The discrepancy between animal and human findings highlights the need for larger, standardized human studies.
TRIAL REGISTRATION
(PROSPERO Registration: CRD42023492732).
背景
重复经颅磁刺激（rTMS）最近在治疗不同精神疾病方面受到关注。有限的证据表明，rTMS对精神病理学的有益作用可能至少部分通过炎症反应的变化来介导。本系统评价总结了关于rTMS是否能调节炎症标志物从而对精神疾病病程产生积极影响的文献。
材料与方法
根据PRISMA指南对rTMS与精神疾病炎症标志物进行系统评价。提取了关于rTMS治疗反应与炎症标志物变化之间关联的信息。使用美国国立心肺血液研究所的人类研究标准和实验室动物实验系统评价中心的动物研究标准对研究质量进行评估。
结果
本评价纳入了17项关于rTMS治疗反应与炎症标志物变化关系的研究（2项动物研究和15项人类研究）。在抑郁症动物模型中，小胶质细胞活性的积极变化和抗炎作用与行为改善相关。然而，这些发现在针对难治性抑郁症的人类研究中并未得到一致重复。虽然有几项研究报告了rTMS引起的外周炎症标志物改变，但只有两项研究能够证明它们与临床治疗反应的关联。值得注意的是，大多数研究在偏倚评估中显示质量较差或中等。
结论
虽然某些人类研究表明rTMS诱导的抗炎作用与精神病理学改善之间存在关联，但异质性和分析效能不足限制了这些结果的普遍性。动物和人类研究结果的差异凸显了开展更大规模、标准化人类研究的必要性。
试验注册
（PROSPERO注册号：CRD42023492732）
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