经颅磁刺激治疗抑郁症和精神分裂症快感缺失的疗效及安全性Meta分析
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黑龙江省自然科学基金联合引导项目( LH2023H099)


Efficacy and safety of transcranial magnetic stimulation for anhedonia in patients with depressivedisorder and schizophrenia: a Meta-analysis
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    摘要:

    目的 通过Meta 分析总结经颅磁刺激(TMS)干预抑郁症和精神分裂症患者快感缺失的 疗效和安全性及相关的影响因素。方法 计算机检索PubMed、Web of Science、Embase、PsycINFO、 CINAHL、The Cochrane Library、中国知网、中国生物医学文献数据库、万方数据库中有关TMS 治疗抑郁 症和精神分裂症患者快感缺失的文献;检索时限自建库至2024年12月。2名研究者独立提取被纳入文献 的相关数据,采用RevMan 5.4.1和Stata 16.0软件进行Meta分析。结果 共纳入18 篇文献,共计1 175 例 患者(抑郁症782 例,精神分裂症393 例)。Meta 分析结果显示,TMS 可以改善抑郁症和精神分裂症快感 缺失,差异有统计学意义(SMD=0.55,95%CI:0.16~0.94,Z=2.74,P=0.006);亚组分析结果显示,采用 TMS 刺激左侧背外侧前额叶皮层(DLPFC)干预快感缺失的疗效优于其他刺激部位,差异有统计学意义 (SMD=0.67,95%CI:0.21~1.13,Z=2.86,P=0.004);采用大于1 Hz的高频TMS 干预快感缺失的疗效优于 其他刺激频率,差异有统计学意义(SMD=0.53,95%CI:0.15~0.90,Z=2.74,P=0.006);TMS 干预时间≥ 4 周的疗效优于其他干预时间,差异达到了统计学中的临界标准(SMD=0.58,95%CI:0.01~1.16, Z=1.98,P=0.05);采用阴性症状量表进行评估时,干预组快感缺失水平的改善优于对照组,差异有统计 学意义(SMD=0.53,95%CI:0.24~0.83,Z=3.54,P=0.000 4);TMS 相对于其他干预措施无明显的不良反 应(RR=0.83,95%CI:0.52~1.33,Z=0.78,P=0.44)。结论 长时高频左侧DLPFC的TMS 可以明显改善抑 郁症和精神分裂症患者快感缺失,且无明显的不良反应。

    Abstract:

    Objective To summarize the efficacy and safety of transcranial magnetic stimulation( TMS) for anhedonia in patients with depressive disorder and schizophrenia and related influencing factors by metaanalysis. Methods The literature on TMS for anhedonia in patients with depressive disorder and schizophrenia was electronically searched in PubMed, Web of Science, Embase, PsycINFO, CINAHL, The Cochrane Library, China National Knowledge Infrastructure, China Biomedical Database, and WanFang Database. The search period was from database establishment to December 2024. Two researchers independently extracted data from the included literature and performed meta-analysis using RevMan 5.4.1 and Stata 16.0. Results A total of 18 papers with a total of 1 175 patients( 782 with depressive disorder and 393 with schizophrenia) were included. Meta-analysis showed that TMS improved anhedonia in depressive disorder and schizophrenia with a statistically significant difference[ SMD=0.55, 95%CI( 0.16,0.94),Z=2.74,P=0.006]. Subgroup analysis showed that the efficacy in anhedonia using TMS in the left dorsolateral prefrontal cortex( DLPFC) was superior to that in other stimulation sites, and the difference was statistically significant[ SMD=0.67,95%CI( 0.21,1.13), Z=2.86,P=0.004]. The efficacy of using high-frequency TMS greater than 1 Hz to intervene in anhedonia was superior to other stimulation frequencies, and the difference was statistically significant[ SMD=0.53, 95%CI (0.15, 0.90), Z=2.74, P=0.006]. The efficacy of the TMS intervention duration of ≥ 4 weeks was superior to the other intervention durations, and the difference met the statistical threshold criterion[ SMD=0.58, 95%CI( 0.01, 1.16), Z=1.98, P=0.05]. When assessed using the Negative Symptoms Scale, the improvement in anhedonia was better in intervention group than that in control group, and the difference was statistically significant[ SMD=0.53, 95%CI( 0.24,0.83), Z=3.54, P=0.000 4]. TMS had no significant adverse effects relative to other interventions[ RR=0.83, 95%CI( 0.52, 1.33), Z=0.78, P=0.44]. Conclusions Longduration, high-frequency and left DLPFC TMS can significantly improve anhedonia in patients with depressive disorder and schizophrenia without significant adverse effects.

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秦玮琪,李平,魏思懿,李善聪,李博,冷佳慧.经颅磁刺激治疗抑郁症和精神分裂症快感缺失的疗效及安全性Meta分析[J].神经疾病与精神卫生,2025,25(9):616-624
DOI :10.3969/j. issn.1009-6574.2025.09.002.

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  • 在线发布日期: 2025-09-16