本文選題：重復(fù)經(jīng)顱磁刺激 + 精神分裂癥��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:對高頻重復(fù)經(jīng)顱磁刺激(rTMS)改善精神分裂癥陰性癥狀的療效及其影響因素進(jìn)行分析。方法:計算機檢索Pubmed、EMbase、Cochrane Library、萬方數(shù)據(jù)庫、CNKI、維普中文期刊數(shù)據(jù)庫(VIP)以及中國學(xué)位論文全文數(shù)據(jù)庫等,收集1997年1月-2016年12月關(guān)于rTMS治療精神分裂癥陰性癥狀的隨機對照研究(RCT)。主要的分析指標(biāo)為陽性與陰性量表(PANSS)中的陰性癥狀及陰性癥狀量表(SANS)。文獻(xiàn)的篩選、資料的提取和方法學(xué)質(zhì)量評價由兩位獨立的研究者進(jìn)行,并且以RevMan5.3軟件進(jìn)行Meta分析。結(jié)果:1 16篇RCT研究符合入組標(biāo)準(zhǔn),共入組924名患者。其中真刺激組487名患者,偽刺激組437名。2對比真刺激組和偽刺激治療后的量表評分發(fā)現(xiàn),兩組之間PANSS-N比較,MD值為-1.39(-2.37至-0.42),有統(tǒng)計學(xué)差異(Z=2.80,P=0.005);當(dāng)用SANS為評估指標(biāo),兩組之間結(jié)果發(fā)現(xiàn)MD值為-8.65(-13.11至-4.18),有統(tǒng)計學(xué)差異(Z=3.80,P=0.001)。3當(dāng)用病程作為亞組分析時發(fā)現(xiàn)病程小于8年的患者用rTMS治療結(jié)果顯示MD值:-2.00,95%CI:-2.92至-1.08,差異有統(tǒng)計學(xué)意義(Z=4.27,P0.00001)。4在刺激閾值上,110%的刺激閾值結(jié)果顯示MD值:-13.60,95%CI:-17.08至-10.12,差異有統(tǒng)計學(xué)意義(Z=7.67,P0.00001)。5在治療病程上,4周的治療療程無論是用SANS還是PANSS評定均較其他治療療程效果好,用SANS作為評估指標(biāo)MD值:-12.90,95%CI:-17.30至-8.51,Z=5.76,P0.00001,用PANSS作為評估指標(biāo)MD值:-2.06,95%CI:-2.99至-1.12,Z=4.32,P0.0001。6在種族上,中國人群PANSS-N量表比較,MD值分別為-1.86(95%CI:-2.71至-1.02)差異有統(tǒng)計學(xué)意義(Z=4.32,P0.00001)。結(jié)論:高頻重復(fù)經(jīng)顱磁刺激輔助治療精神分裂癥陰性癥狀有效,病程時間越短,治療效果越好。110%的刺激閾值為最佳刺激閾值,治療療程要至少4周以上。與外國人群相比,中國人群對重復(fù)經(jīng)顱磁刺激更為敏感。
[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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R749.3

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