高频重复经颅磁刺激辅助治疗精神分裂症阴性症状疗效的Meta分析

发布时间：2018-06-27 08:37

本文选题：重复经颅磁刺激 + 精神分裂症　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:对高频重复经颅磁刺激(rTMS)改善精神分裂症阴性症状的疗效及其影响因素进行分析。方法:计算机检索Pubmed、EMbase、Cochrane Library、万方数据库、CNKI、维普中文期刊数据库(VIP)以及中国学位论文全文数据库等,收集1997年1月-2016年12月关于rTMS治疗精神分裂症阴性症状的随机对照研究(RCT)。主要的分析指标为阳性与阴性量表(PANSS)中的阴性症状及阴性症状量表(SANS)。文献的筛选、资料的提取和方法学质量评价由两位独立的研究者进行,并且以RevMan5.3软件进行Meta分析。结果:1 16篇RCT研究符合入组标准,共入组924名患者。其中真刺激组487名患者,伪刺激组437名。2对比真刺激组和伪刺激治疗后的量表评分发现,两组之间PANSS-N比较,MD值为-1.39(-2.37至-0.42),有统计学差异(Z=2.80,P=0.005);当用SANS为评估指标,两组之间结果发现MD值为-8.65(-13.11至-4.18),有统计学差异(Z=3.80,P=0.001)。3当用病程作为亚组分析时发现病程小于8年的患者用rTMS治疗结果显示MD值:-2.00,95%CI:-2.92至-1.08,差异有统计学意义(Z=4.27,P0.00001)。4在刺激阈值上,110%的刺激阈值结果显示MD值:-13.60,95%CI:-17.08至-10.12,差异有统计学意义(Z=7.67,P0.00001)。5在治疗病程上,4周的治疗疗程无论是用SANS还是PANSS评定均较其他治疗疗程效果好,用SANS作为评估指标MD值:-12.90,95%CI:-17.30至-8.51,Z=5.76,P0.00001,用PANSS作为评估指标MD值:-2.06,95%CI:-2.99至-1.12,Z=4.32,P0.0001。6在种族上,中国人群PANSS-N量表比较,MD值分别为-1.86(95%CI:-2.71至-1.02)差异有统计学意义(Z=4.32,P0.00001)。结论:高频重复经颅磁刺激辅助治疗精神分裂症阴性症状有效,病程时间越短,治疗效果越好。110%的刺激阈值为最佳刺激阈值,治疗疗程要至少4周以上。与外国人群相比,中国人群对重复经颅磁刺激更为敏感。
[Abstract]:Objective: to analyze the effect of high frequency repetitive transcranial magnetic stimulation (rTMS) on the negative symptoms of schizophrenia. Methods: Pubmedmedus EMbase Cochrane Library, Wanfang database CNKI, VIP database and full text database of Chinese degree papers were searched. The randomized controlled study (RCT) of rTMS in the treatment of schizophrenia negative symptoms from January 1997 to December 2016 was collected. The positive and negative symptom scale (sans) was the main analysis index. Literature screening, data extraction and methodological quality evaluation were carried out by two independent researchers, and Meta-analysis was performed with Revman 5.3 software. Results one hundred and sixteen RCT studies conformed to the admission criteria, involving 924 patients. Of the 487 patients in the true stimulation group and 437 in the pseudo-stimulation group, the scores of PANSS-N were -1.39 (-2.37 to -0.42) in comparison with the true stimulation group and 437 in the pseudo-stimulation group, and there was statistical difference between the two groups (Z _ (2.80) P _ (0.005). The MD value between the two groups was -8.65 (-13.11 to -4.18), and there was statistical difference (ZH3.80 / P0.001) .3 when the course of disease was used as a subgroup analysis, the patients with a course of less than 8 years were treated with rTMS. The results of rTMS showed that the MD value: -2.00 ~ 95CI-2.92 to -1.08, the difference was statistically significant (ZH4.27P0.00001). The stimulation threshold value of 110% showed that the MD value: -13.60,95CI: -17.08 to -10.12, the difference was statistically significant (ZH7.67 P0.00001) .5 in the course of treatment for 4 weeks, both sans and PANSS were better than other courses of treatment. Using sans as the evaluation index, MD: -12.90 / 95CI-17.30 to -8.51a, P 0.00001, using PANSS as the evaluation index, MD: -2.0695 CI: -2.99 to -1.12 ~ 4.32P0.0001.6 in race, the difference of MD between -1.86 (95CIW-2.71 to -1.02) in Chinese population was statistically significant (Z4.32P 0.00001). Conclusion: high frequency repetitive transcranial magnetic stimulation is effective in the treatment of negative symptoms of schizophrenia. The shorter the course of disease is, the better the therapeutic effect is. 110% of the stimulation threshold is the best stimulation threshold, and the course of treatment should be more than 4 weeks. Chinese people are more sensitive to repetitive transcranial magnetic stimulation than foreigners.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.3

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