青少年重度抑郁症患者电休克治疗后认知功能改变的Meta分析

Meta-Analysis of Cognitive Function Changes after Electroconvulsive Therapy in Adolescents with Major Depressive Disorder

摘要: 目的：系统评价电休克治疗(ECT)对青少年重度抑郁症(MDD)患者短期及长期认知功能的影响，并探究不同认知维度及联合艾司氯胺酮的调节作用。方法：计算机检索PubMed、Embase、Cochrane Library、CNKI、万方等数据库，搜集关于ECT治疗青少年MDD的随机对照试验(RCT)和队列研究，检索时限均为建库至2025年10月30日。纳入标准包括经诊断为MDD的10~19岁患者，且提供标准化的认知评估数据。采用Cochrane风险偏倚工具和纽卡斯尔–渥太华量表(NOS)评价质量，使用RevMan 5.3和Stata 16.1软件进行Meta分析。结果：最终纳入6项研究，共包含584例患者。Meta分析结果显示：① 短期(疗程结束10天内)整体认知功能与基线相比差异无统计学意义(SMD = −0.04, 95% CI: −0.35~0.26, P = 0.79)。② 长期(疗程结束1个月以上)整体认知功能较基线显著改善(SMD = 0.63, 95% CI: 0.43~0.83, P < 0.0001)。③ 亚组分析显示，联合艾司氯胺酮麻醉组(SMD = 0.27)与常规麻醉组相比，差异无统计学意义(P = 0.08)。④ 认知维度方面，治疗后执行功能显著改善(P = 0.03)，注意力呈改善趋势(P = 0.06)，但空间记忆和言语记忆在短期内受到轻度抑制(P < 0.05)。结论：ECT治疗青少年MDD在短期内未造成整体认知损害，虽引起特定记忆领域的暂时性波动，但长期随访显示其有助于改善整体认知水平，尤其是执行功能。至于联合艾司氯胺酮麻醉对认知功能的具体调节作用，目前的证据尚不足以得出确切结论，有待进一步研究验证。

Abstract: Objective: To systematically evaluate the short-term and long-term effects of electroconvulsive therapy (ECT) on cognitive function in adolescents with major depressive disorder (MDD), and to explore the regulatory effects of different cognitive dimensions and combined esketamine. Methods: Databases including PubMed, Embase, Cochrane Library, CNKI, and Wanfang Data were searched for randomized controlled trials (RCTs) and cohort studies on ECT for adolescent MDD from inception to October 30, 2025. Inclusion criteria involved patients aged 10~19 diagnosed with MDD and provided standardized cognitive assessment data. Quality was assessed using the Cochrane risk of bias tool and the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using RevMan 5.3 and Stata 16.1 software. Results: Six studies involving 584 patients were finally included. Meta-analysis results showed: (1) There was no statistically significant difference in short-term (within 10 days after treatment) global cognitive function compared with baseline (SMD = −0.04, 95% CI: −0.35 to 0.26, P = 0.79). (2) Long-term (more than 1 month after treatment) global cognitive function significantly improved compared with baseline (SMD = 0.63, 95% CI: 0.43 to 0.83, P < 0.0001). (3) Subgroup analysis showed that the difference between the esketamine-combined anesthesia group (SMD = 0.27) and the conventional anesthesia group was not statistically significant (P = 0.08). (4) Regarding cognitive dimensions, executive function significantly improved after treatment (P = 0.03), and attention showed an improving trend (P = 0.06), while spatial memory and verbal memory were mildly inhibited in the short term (P < 0.05). Conclusion: ECT does not cause global cognitive impairment in adolescents with MDD in the short term. Although it causes temporary fluctuations in specific memory domains, long-term follow-up shows it helps improve overall cognitive levels, especially executive function. Combined esketamine anesthesia requires further investigation regarding its potential role in cognitive outcomes, as current evidence is inconclusive.