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期刊来源：Nat Med

原文链接：https://doi.org/10.1038/s41591-023-02764-z

摘要内容如下：

右侧前岛叶和左侧背外侧前额叶皮层之间的相互连接中断与抑郁症有关，可能是神经调节的靶点。在一项五中心、平行、双盲、随机对照试验中，我们根据右侧前岛叶到左侧背外侧前额叶皮层的有效连接，在一个部位进行了个性化静息态功能磁共振成像神经导航连接引导的间歇性θ爆发刺激（CGITBS）。我们在8周、16周和26周的时间内，与在标准刺激部位（F3）进行的结构性磁共振成像（MRI）神经导航重复经颅磁刺激（rTMS）相比，在“难治性抑郁症”患者中，通过Grid Hamilton抑郁量表17项测量，测试了其在减少主要结果抑郁症状方面的功效。参与者被随机分配到CGITBS（n=128）或rTMS（n=127）的20个疗程，为期4-6周，并在基线和16周时进行静息态功能MRI检查。在26周内观察到抑郁症状持续减少，在主要结果网格汉密尔顿抑郁量表17项评分上两组之间没有差异（意向治疗调整平均值，-0.31，95%置信区间（CI）-1.87，1.24，P=0.689）。两个严重不良事件可能与经颅磁刺激（TMS）有关（躁狂和精神病）。MRI-神经导航CGITBS和rTMS对26周以上的难治性抑郁症患者同样有效（试验注册号：ISRCTN19674644）。

英文原文如下：

Abstracts

Disruption in reciprocal connectivity between the right anterior insula and the left dorsolateral prefrontal cortex is associated with depression and may be a target for neuromodulation. In a five-center, parallel, double-blind, randomized controlled trial we personalized resting-state functional magnetic resonance imaging neuronavigated connectivity-guided intermittent theta burst stimulation (cgiTBS) at a site based on effective connectivity from the right anterior insula to the left dorsolateral prefrontal cortex. We tested its efficacy in reducing the primary outcome depression symptoms measured by the GRID Hamilton Depression Rating Scale 17-item over 8, 16 and 26 weeks, compared with structural magnetic resonance imaging (MRI) neuronavigated repetitive transcranial magnetic stimulation (rTMS) delivered at the standard stimulation site (F3) in patients with 'treatment-resistant depression'. Participants were randomly assigned to 20 sessions over 4-6 weeks of either cgiTBS (n = 128) or rTMS (n = 127) with resting-state functional MRI at baseline and 16 weeks. Persistent decreases in depressive symptoms were seen over 26 weeks, with no differences between arms on the primary outcome GRID Hamilton Depression Rating Scale 17-item score (intention-to-treat adjusted mean, -0.31, 95% confidence interval (CI) -1.87, 1.24, P = 0.689). Two serious adverse events were possibly related to TMS (mania and psychosis). MRI-neuronavigated cgiTBS and rTMS were equally effective in patients with treatment-resistant depression over 26 weeks (trial registration no. ISRCTN19674644).

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