A systematic review and meta-analysis of deep brain stimulation in treatment-resistant depression.
A systematic review and meta-analysis of deep brain stimulation in treatment-resistant depression.
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对难治性抑郁症的深部脑刺激的系统回顾和荟萃分析。
DOI：
10.1016/j.pnpbp.2017.11.012
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发表时间：
2018
影响因子：
5.6
通讯作者：
Xie Peng
中科院分区：
文献类型：
--
作者：
Zhou Chanjuan;Zhang Hanping;Qin Yinhua;Tian Tian;Xu Bing;Chen Jianjun;Zhou Xinyu;Zeng Li;Fang Liang;Qi Xunzhong;Lian Bin;Wang Haiyang;Hu Zicheng;Xie Peng
背景深部脑刺激（DBS）已作为针对不同大脑区域的假定干预措施应用于难治性抑郁症（TRD）。然而，最近的临床试验中 DBS 对 TRD 的抗抑郁作用仍存在争议。方法我们检索了 Scopus、EMBASE、Cochrane Library、PubMed 和 PsycINFO，以查找截至 2017 年 2 月所有调查 DBS 对 TRD 疗效的已发表研究。使用标准化平均差，比较基线水平和 DBS 后的汉密尔顿抑郁量表 (HDRS) 评分和蒙哥马利-阿斯伯格抑郁量表 (MARDS) 评分(SMD)，置信区间 (CI) 为 95%。使用 95% CI 的风险差异来描述汇总反应率和缓解率。 结果我们确定了 14 项针对 TRD 中 DBS 的研究，针对胼胝体下扣带回 (SCG)、腹侧囊/腹侧纹状体 (VC/VS)、内侧前脑束 (MFB) 和伏隔核 (NAcc)。总体效应大小显示，在这四个区域进行 DBS 刺激后，HDRS 显着降低，SCG 的标准化平均差为 − 3.02（95% CI = − 4.28 至 − 1.77，p< 0.00001），VC/VS 为 − 1.64（95% CI = − 2.80 至 − 0.49，p= 0.005）， MFB 为 − 2.43（95% CI = − 3.66 至 − 1.19，p= 0.0001），NAcc 为 − 1.30（95% CI = − 2.16 至 − 0.44，p= 0.003）。 DBS 非常有效，在 1、3、6 和 12 个月时的回复率很高。 DBS治疗期间发生了一些不良事件（AE），特别是一些与靶向区域相关的特定AE。结论DBS通过针对SCG、VC/VS、MFB和NAcc，显着减轻TRD患者的抑郁症状。 DBS 治疗期间可能会发生一些不良事件，但尚不确定某些 AE 是否与 DBS 治疗有关。需要涉及更大样本量的进一步验证性试验。
BackgroundDeep brain stimulation (DBS) has been applied in treatment-resistant depression (TRD) as a putative intervention targeting different brain regions. However, the antidepressant effects of DBS for TRD in recent clinical trials remain controversial.MethodsWe searched Scopus, EMBASE, the Cochrane Library, PubMed, and PsycINFO for all published studies investigating the efficacy of DBS in TRD up to Feb 2017. Hamilton depression rating scale (HDRS) scores and Montgomery–Asberg depression rating scale (MARDS) scores were compared between baseline levels and those after DBS using the standardized mean difference (SMD) with 95% confidence intervals (CIs). The pooled response and remission rates were described using Risk Difference with 95% CIs.ResultsWe identified 14 studies of DBS in TRD targeting the subcallosal cingulate gyrus (SCG), ventral capsule/ventral striatum (VC/VS), medial forebrain bundle (MFB), and nucleus accumbens (NAcc). The overall effect sizes showed a significant reduction in HDRS after DBS stimulation in these four regions, with a standardized mean difference of − 3.02 (95% CI = − 4.28 to − 1.77,p< 0.00001) for SCG, − 1.64 (95% CI = − 2.80 to − 0.49,p= 0.005) for VC/VS, − 2.43 (95% CI = − 3.66 to − 1.19,p= 0.0001) for MFB, and − 1.30 (95% CI = − 2.16 to − 0.44,p= 0.003) for NAcc. DBS was effective, with high response rates at 1, 3, 6, and 12 months. Some adverse events (AEs), especially some specific AEs related to targeting regions, occurred during the DBS treatment.ConclusionsDBS significantly alleviates depressive symptoms in TRD patients by targeting the SCG, VC/VS, MFB, and NAcc. Several adverse events might occur during DBS therapy, although it is uncertain whether some AEs can be linked to DBS treatment. Further confirmatory trials are required involving larger sample sizes.