重复经颅磁刺激治疗产后抑郁的效果及安全性的Meta分析

Efficacy and safety of repetitive transcranial magnetic stimulation in the treatment of postpartum depression： a Meta-analysis

中文关键词:  重复经颅磁刺激  产后抑郁  Meta分析

英文关键词:Repetitive transcranial magnetic stimulation  Postpartum depression  Meta-analysis

中文摘要:

      背景 产后抑郁（PPD）是常见的产后并发症之一，严重危害妇女心理和生理健康。重复经颅磁刺激（rTMS）作为一种常规的神经调控技术，已广泛应用于PPD的治疗。但关于rTMS治疗PPD的效果及安全性的循证证据有限。目的 考查rTMS治疗PPD的效果及安全性，以期为PPD的临床治疗提供参考。方法 计算机检索Cochrane Library、PubMed、Embase、中国知网、万方、维普以及中国生物医学文献数据库，收集rTMS治疗PPD的随机对照试验，检索时限为建库至2025年2月8日。采用Cochrane干预措施系统评价手册5.0.1对纳入文献进行质量评价，采用证据推荐分级的评估、制订与评价（GRADE）方法进行证据等级评估。采用RevMan 5.3和Stata 12.0进行Meta分析。Meta分析结局指标包括治疗总有效率、爱丁堡产后抑郁量表（EPDS）评分、汉密尔顿抑郁量表（HAMD）评分以及不良反应（头晕头痛、恶心、腹泻、不良反应总发生率）。结果 共纳入11篇文献，包含729例PPD患者。Meta分析结果显示，研究组总有效率（OR=5.54，95% CI：3.07~10.01，P<0.01）高于对照组；EPDS评分（SMD=-2.38，95% CI：-3.39~-1.37，P<0.01）及HAMD评分（SMD=2.53，95% CI：1.21~3.85，P<0.01）均低于对照组，差异均有统计学意义。研究组与对照组发生头晕头痛（RR=1.47， 95% CI：0.63~3.43，P>0.05）、恶心（RR=1.46，95% CI：0.55~3.86，P>0.05）、腹泻（RR=0.71，95% CI：0.23~2.20，P>0.05）的比例以及不良反应总发生率（RR=1.30，95% CI：0.79~2.15，P>0.05）比较，差异均无统计学意义。其中，头晕头痛、腹泻、不良反应总发生率及EPDS评分四个指标为“中级证据”；总有效率、恶心及HAMD评分三个指标为“低级证据”。结论 rTMS对PPD具有一定疗效，且安全性与常规治疗相当。

英文摘要:

      Background Postpartum depression （PPD） is a prevalent postpartum complications that significantly compromises women's psychological and physical well-being. Repetitive transcranial magnetic stimulation （rTMS）， a conventional neuromodulation technique， has been increasingly used in the treatment of PPD. However， high-quality evidence regarding its efficacy and safety remains limited.Objective To evaluate the efficacy and safety of rTMS in the treatment of PPD， thereby providing references for clinical treatment.Methods Databases including Cochrane Library， PubMed， Embase， CNKI， Wanfang， VIP and China Biology Medicine disc （CBM） were electronically searched for randomized controlled trials （RCTs） on rTMS for PPD， with the search spanning from database inception to February 8， 2025. Study quality was assessed using the Cochrane Handbook for Systematic Reviews of Interventions 5.0.1， and the certainty of evidence was graded according to the Grading of Recommendations Assessment， Development and Evaluation （GRADE） approach. Meta-analysis was conducted using RevMan 5.3 and Stata 12.0. The outcomes of the Meta-analysis included the total effective rate， Edinburgh Postnatal Depression Scale （EPDS） score， Hamilton Depression Rating Scale （HAMD） score， and adverse reactions （dizziness， headache， nausea， diarrhea， and the overall incidence of adverse reactions）.Results A total of 11 studies involving 729 patients with PPD were included. Meta-analysis results showed that the total effective rate in the study group was significantly higher than that in the control group （OR=5.54， 95% CI： 3.07–10.01， P<0.01）. Both EPDS score （SMD=-2.38， 95% CI： -3.39–-1.37， P<0.01） and HAMD score （SMD=2.53， 95% CI： 1.21–3.85， P<0.01） in the study group were significantly lower than those in the control group， with statistically significant differences. Comparisons between the study group and control group reveal no significant differences in the incidence of dizziness and headache （RR=1.47， 95% CI： 0.63–3.43， P>0.05）， nausea （RR=1.46， 95% CI： 0.55–3.86， P>0.05）， diarrhea （RR=0.71， 95% CI： 0.23–2.20， P>0.05）， and overall adverse reactions （RR=1.30， 95% CI： 0.79–2.15， P>0.05）. GRADE assessment rated the four indicators of dizziness and headache， diarrhea， overall incidence of adverse reactions， and EPDS score as "moderate-certainty evidence"， and rated the total effective rate， nausea， and the HAMD score as "low-certainty evidence".Conclusion rTMS demonstrates certain therapeutic efficacy for PPD， with a safety profile comparable to conventional treatment. ［Funded by Sichuan Psychological Society Research Planning Project （number， SCSXLXH202403099）； Guiding Science and Technology Plan Project of Guangyuan （number， 23ZDYF0095）］