中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2013, Vol. 8 ›› Issue (28): 2666-2676.doi: 10.3969/j.issn.1673-5374.2013.28.009

• 原著:神经损伤修复保护与再生 • 上一篇    下一篇

重复经颅磁刺激可改善精神分裂症谱系障碍患者幻听症状？

  

  • 收稿日期:2013-04-23 修回日期:2013-07-24 出版日期:2013-10-05 发布日期:2013-10-05
  • 基金资助:

    河南卫生科技创新人才项目专项资金，4173号（2010-2015）和高层次人才科学研究项目（08bskyqd-004）；河南教育部科学和技术研究重点项目（13a320869）

Repetitive transcranial magnetic stimulation for hallucination in schizophrenia spectrum disorders A meta-analysis

Yingli Zhang1, Wei Liang2, Shichang Yang3, Ping Dai4, Lijuan Shen5, Changhong Wang6   

  1. 1 Psychological Counseling Center, Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, Henan Province, China
    2 Department of Clinical Psychology, Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, Henan Province, China
    3 Department of Psychology, Xinxiang Medical University, Xinxiang 453000, Henan Province, China
    4 Library of Sichuan University, Chengdu 610041, Sichuan Province, China
    5 Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
    6 Department of Psychiatry, Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, Henan Province, China
  • Received:2013-04-23 Revised:2013-07-24 Online:2013-10-05 Published:2013-10-05
  • Contact: Changhong Wang, M.D., Professor, Department of Psychiatry, Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, Henan Province, China, wangch3669@yahoo.com.cn
  • About author:Yingli Zhang, Studying for doctorate, Chief physician. Yingli Zhang and Wei Liang contributed equally to this paper.
  • Supported by:

    This study was financially sponsored by the Special Funding of Henan Health Science and Technology Innovation Talent Project, No. 4173(2010-2015); Xinxiang Medical University of High-Level Personnel of Scientific Research Projects, No. 08BSKYQD-004, and the Key Projects of Science and Technology Research of Department of Education in Henan, No. 13A320869.

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摘要：

目的：系统评价重复经颅磁刺激治疗精神分裂症谱系障碍患者幻听症状的安全性和耐受性。
资料来源：检索PubMed，ISI, EMBASE, Medline数据库和Cochrane中心注册的随机对照研究，文献时间为1985-01/2012-05。检索词：“transcranial magnetic stimulation”, “TMS”, “rTMS”, AND “hallucination”。
资料选择：选择的文献均为随机对照研究，主题为重复经颅磁刺激治疗精神分裂症谱系障碍的幻听。纳入文献的研究组用低频经颅磁刺激刺激左侧颞叶皮质治疗精神分裂症谱系障碍的幻听，对照组用伪刺激治疗幻听。
结局评价指标：主要结局指标为幻听量表评分，包括幻听评定量表、精神症状评定量表-幻听分量表、阳性阴性症状量表-幻听分量表、幻听变化量表，如果无以上量表就用阳性阴性症状量表-阳性症状分量表或阳性症状评定量表。次要结局包括有效率、一般精神病性症状、不良反应和认知功能。
结果：共筛查出17个以伪刺激作为对照的重复经颅磁刺激治疗精神分裂症谱系障碍幻听的研究，所有文章均有充分有效的数据信息。17项研究共398例患者。重复经颅磁刺激真刺激和伪刺激治疗精神分裂症谱系障碍的幻听的总效应值差异有显著性意义 [MD= -0.42, 95%CI: -0.64- -0.20, P=0.0002]。重复经颅磁刺激有效率显著高于伪刺激[OR=2.94, 95%CI: 1.39-6.24, P=0.005]。与伪刺激相比，重复经颅磁刺激对精神分裂症谱系障碍幻听的阳性症状和阴性症状治疗效果，及对认知功能的影响均差异无显著性意义。重复经颅磁刺激治疗后患者常出现轻度头痛、面部肌肉颤动，但无认知功能损害。
结论：重复经颅磁刺激可改善精神分裂症谱系障碍患者的幻听症状，方法安全有效。

关键词: 神经再生, 循证医学, 经颅磁刺激, 幻听, 精神分裂症, 精神分裂症谱系障碍, 精神病性障碍, 颞叶皮质, 认知功能, 阳性症状, 基金资助文章

Abstract:

OBJECTIVE: This study assessed the efficacy and tolerability of repetitive transcranial magnetic stimulation for treatment of auditory hallucination of patients with schizophrenia spectrum disorders.
DATA SOURCES: Online literature retrieval was conducted using PubMed, ISI Web of Science, EMBASE, Medline and Cochrane Central Register of Controlled Trials databases from January 1985 to May 2012. Key words were “transcranial magnetic stimulation”, “TMS”, “repetitive transcranial magnetic stimulation”, and “hallucination”.
STUDY SELECTION: Selected studies were randomized controlled trials assessing therapeutic ef-ficacy of repetitive transcranial magnetic stimulation for hallucination in patients with schizophrenia spectrum disorders. Experimental intervention was low-frequency repetitive transcranial magnetic stimulation in left temporoparietal cortex for treatment of auditory hallucination in schizophrenia spectrum disorders. Control groups received sham stimulation.
MAIN OUTCOME MEASURES: The primary outcome was total scores of Auditory Hallucinations Rating Scale, Auditory Hallucination Subscale of Psychotic Symptom Rating Scale, Positive and Negative Symptom Scale-Auditory Hallucination item, and Hallucination Change Scale. Secondary outcomes included response rate, global mental state, adverse effects and cognitive function.
RESULTS: Seventeen studies addressing repetitive transcranial magnetic stimulation for treatment of schizophrenia spectrum disorders were screened, with controls receiving sham stimulation. All data were completely effective, involving 398 patients. Overall mean weighted effect size for repeti-tive transcranial magnetic stimulation versus sham stimulation was statistically significant (MD = –0.42, 95%CI: –0.64 to –0.20, P = 0.000 2). Patients receiving repetitive transcranial magnetic stimulation responded more frequently than sham stimulation (OR = 2.94, 95%CI: 1.39 to 6.24, P =0.005). No significant differences were found between active repetitive transcranial magnetic stimulation and sham stimulation for positive or negative symptoms. Compared with sham stimulation, active repeti-tive transcranial magnetic stimulation had equivocal outcome in cognitive function and commonly caused headache and facial muscle twitching.
CONCLUSION: Repetitive transcranial magnetic stimulation is a safe and effective treatment for auditory hallucination in schizophrenia spectrum disorders.

Key words: neural regeneration, meta-analysis, transcranial magnetic stimulation, auditory hallucination, schizophre-nia, schizophrenia spectrum disorders, schizophreniform disorder, temporoparietal cortex, cognitive func-tion, positive symptom, grants-supported paper, neuroregeneration