摘要
目的 系统评价重复经颅磁刺激(rTMS)对失眠患者主观睡眠质量的疗效,为rTMS治疗失眠提供循证依据。方法 系统检索PubMed、Embase、Cochrane Library、万方数据库、维普中文期刊数据库、中国生物医学文献数据库和中国期刊全文数据库,纳入关于rTMS治疗失眠或睡眠障碍的随机对照研究。由两名研究者独立筛选文献、提取数据,并对纳入文献的方法学质量进行评价。采用RevMan 5.2进行Meta分析,采用Stata 13.0分析发表偏倚。结果 最终纳入13篇文献,共889例患者。Meta分析结果显示:rTMS治疗组睡眠质量改善的效果优于对照组(SMD=-1.11,95% CI:-1.46^-0.76,Z=6.22, P <0.01 )。亚组分析结果显示,针对原发性和继发性失眠患者,rTMS治疗组睡眠质量改善的效果均优于对照组(原发性: SMD=-1.22 ,95% CI:-1.72^-0.72,Z=4.77,P<0.01;继发性:SMD=-1.04,95% CI:-1.55^-0.54,Z=4.04,P <0.01)。高频和低频rTMS对患者睡眠质量评分的改善效果均优于对照组(高频:SMD=-0.44,95% CI:-0.76^-0.13,Z=2.73, P< 0.01;低频:SMD=-1.24,95% CI:-1.61^-0.86,Z=6.45,P <0.01)。结论 高频或低频rTMS联合常规治疗对失眠患者主观睡眠质量的改善效果更佳,对原发性和继发性失眠均有效。
Objective To systematically investigate the effect of repeated transcranial magnetic stimulation (rTMS) on subjective sleep quality in patients with insomnia, so as to provide evidence-based basis for the treatment of insomnia by rTMS. Methods Randomized controlled trials (RCTs) about the treatment of insomnia by rTMS published in foreign and domestic databases , including PubMed, Embase, Cochrance Library,Wanfang, VIP, Chinese biomedical literature database and CNKI were retrieved . The following procedures including literature selection, data extraction and quality evaluation were performed independently by two researchers. Then the RevMan 5.2 was used for meta-analysis and Stata 13.0 was used for publication bias analysis. Results A total of 13 RCTs (n=889) were enrolled.Meta-analysis results showed that the sleep quality improvement effect of the rTMS group was better than that of the control group (SMD=-1.11, 95% CI:-1.46^-0.76, Z=6.22, P<0.01). Subgroup analysis showed that the sleep quality improvement effect for primary and secondary insomnia patients in rTMS group was better than that in control group ( primary : SMD=-1.22, 95% CI:-1.72^-0.72,Z=4.77, P <0.01;secondary: SMD=-1.04, 95% CI:-1.55^-0.54, Z=4.04, P <0.01). The sleep quality improvement effect of high-frequency and low-frequency rTMS was better than that of control group (high-frequency: SMD=-0.44, 95% CI:-0.76^-0.13, Z=2.73, P<0.01;low- frequency: SMD=-1.24, 95% CI:-1.61^-0.86, Z=6.45, P <0.01). Conclusion High-frequency or low-frequency rTMS combined with conventional therapy can effectively ameliorate the subjective sleep quality of insomniacs, which is also effective for both primary and secondary insomnia .
作者
边云
马泊涛
王智雄
林晨
韩笑乐
杨甫德
Bian Yun;Ma Botao;Wang Zhixiong;Lin Chen;Han Xiaole;Yang Fude(Peking University Huilongguan Clinical Medical School, Beijing 100096, China;Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory ofMental Health, Ministry of Health (Peking University), Beijing 100191, China)
出处
《四川精神卫生》
2019年第3期216-222,共7页
Sichuan Mental Health
基金
北京市属医院科研培育计划(PX2018066)
关键词
失眠症
经颅磁刺激
睡眠质量
META分析
Insomnia
Transcranial magnetic stimulation
Sleep quality
Meta-analysis
