重复经颅磁刺激治疗脑外伤患者认知障碍的Meta分析

doi:10.3969/j.issn.1006-9771.2021.11.007

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (11): 1282-1290.doi: 10.3969/j.issn.1006-9771.2021.11.007

重复经颅磁刺激治疗脑外伤患者认知障碍的Meta分析

韩凯月^1,²,党辉^1,^3,⁴,张皓^1,^2,⁴()

1.首都医科大学康复医学院,北京市 100068
2.中国康复研究中心北京博爱医院,北京市 100068
3.山东大学齐鲁医学院,山东济南市 250100
4.康复大学,山东青岛市 266000

收稿日期:2021-08-20 修回日期:2021-09-18 出版日期:2021-11-25 发布日期:2021-12-03
通讯作者: 张皓 E-mail:crrczh2020@163.com
作者简介:韩凯月(1998-),女,汉族,山东淄博市人,硕士研究生,主要研究方向：神经康复。|张皓(1965-),女,汉族,北京市人,博士,教授、主任医师,博士研究生导师,主要研究方向：脑外伤康复。
基金资助:
1.国家重点研发计划项目(2018YFC2001703);2.中国康复研究中心重点课题(2021ZX-02)

Efficacy of Repetitive Transcranial Magnetic Stimulation on Cognitive Dysfunction after Traumatic Brain Injury: A Meta-analysis

HAN Kai-yue^1,²,DANG Hui^1,^3,⁴,ZHANG Hao^1,^2,⁴()

1. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
2. Beijing Bo'ai Hospital, China Rehabilitation Research Centre, Beijing 100068, China
3. Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong 250100, China
4. University of Health and Rehabilitation Sciences, Qingdao, Shandong 266000, China

Received:2021-08-20 Revised:2021-09-18 Published:2021-11-25 Online:2021-12-03
Contact: ZHANG Hao E-mail:crrczh2020@163.com
Supported by:
National Key Research and Development Plan(2018YFC2001703);China Rehabilitation Research Center Key Project(2021ZX-02)

摘要/Abstract

摘要：

目的系统评价重复经颅磁刺激(rTMS)对脑外伤(TBI)患者认知障碍的疗效。方法从PubMed、Embase、Web of Science、Cochrane Library、中国知网、万方、维普、中国生物医学期刊引文数据库检索自建库至2021年6月全文发表的关于rTMS治疗脑外伤患者认知障碍的随机对照试验。由2名研究者独立进行文献筛选、数据提取、质量评价,采用RevMan 5.4软件进行Meta分析。结果共纳入10个随机对照试验,368例患者。亚组分析表明,rTMS能改善患者的单一认知功能(SMD = 1.00, 95%CI 0.04~1.96, P = 0.04),但对改善总体认知功能无明显效果(SMD = 0.47, 95%CI -0.05~0.98, P = 0.08)。rTMS耐受性良好,虽出现头晕、轻微头痛等不良反应,但与对照组相比无显著性差异(RR = 1.67, 95%CI 0.98~2.86, P = 0.06)。结论 rTMS对脑外伤患者认知障碍的治疗效果尚不明确,但耐受性良好。

关键词: 重复经颅磁刺激, 脑外伤, 认知障碍, Meta分析

Abstract:

Objective To evaluate the effect of repetitive transcranial magnetic stimulation (rTMS) on cognitive dysfunction after traumatic brain injury (TBI).Methods Randomized controlled trials (RCTs) of rTMS for treating traumatic brain injury (TBI) patients with cognitive dysfunction were retrieved from the databases of PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang Database, VIP and SinoMed from the establishment of these databases to June, 2021. Two researchers independently screened the articles, extracted the data, and evaluated the quality. Meta-analysis was performed using RevMan 5.4.Results A total of ten RCTs with 368 patients were included. Subgroup analysis showed that rTMS could improve the single cognitive function (SMD = 1.00, 95%CI 0.04 to 1.96, P = 0.04) but for overall cognitive function (SMD = 0.47, 95%CI -0.05 to 0.98, P = 0.08). rTMS was well tolerated, that the adverse reactions such as dizziness and mild headache were not significantly different from the control group (RR = 1.67, 95%CI 0.98 to 2.86, P = 0.06).Conclusions It is still uncertain in the effectiveness of rTMS on cognitive dysfunction after TBI, but it is well tolerated.

Key words: repetitive transcranial magnetic stimulation, traumatic brain injury, cognitive dysfunction, meta-analysis

韩凯月,党辉,张皓. 重复经颅磁刺激治疗脑外伤患者认知障碍的Meta分析[J]. 《中国康复理论与实践》, 2021, 27(11): 1282-1290.

HAN Kai-yue,DANG Hui,ZHANG Hao. Efficacy of Repetitive Transcranial Magnetic Stimulation on Cognitive Dysfunction after Traumatic Brain Injury: A Meta-analysis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(11): 1282-1290.

图/表 9

框1

图1

表1

纳入研究基本特征"

纳入研究	国家	研究对象(T/C, n)	性别(男/女, n)	平均年龄 (岁)	平均病程 (年)	干预措施	刺激部位	rTMS治疗方案	结局指标	随访时间 (年)	脱落率 (T/C, n)
Stilling等(2020)^[27]	加拿大	10/10	2/18	36.00±11.40	2.71±1.16	T:rTMS C:假刺激	左侧DLFFC	“8”字形线圈,10 Hz,70% RMT,600个脉冲,1次/d,5 d/周,共2周	②	0.5	0/0
Neville等(2019)^[26]	巴西	13/17	27/3	T:32.6±12.81 C:29.0±10.35	> 1	T:rTMS C:假刺激	左侧DLFFC	“8”字形线圈,10 Hz,110% RMT,2000个脉冲,1次/d,5 d/周,共2周	③⑦⑧⑨	0.25	5/1
Hoy等(2019)^[23]	澳大利亚	11/10	10/11	T:41.3±10.04 C:51.8±13.38	T:14.73±10.83 C:22.11±13.59	T:rTMS C:假刺激	双侧DLFFC	“8”字形线圈,按先右后左的顺序治疗。右侧,1 Hz, 110% RMT,900个脉冲;左侧,1 Hz,110% RMT,1500个脉冲。1次/d,5 d/周,共4周	③⑦⑧	无	1/2
Lee等(2018)^[24]	韩国	7/6	9/4	T:42.4±11.32 C:41.3±11.02	T:3.85±1.67 C:3.88±1.94	T:rTMS+NDT C:假刺激+NDT	右侧DLFFC	“8”字形线圈,1 Hz,100% RMT,2000个脉冲,1次/d,5 d/周,共2周	①③⑦	无	0/0
Boggio等(2010)^[25]	巴西	9/8	5/12	T:40.7±13.65 C:45.9±11.45	T:4.12±4.61 C:3.42±4.48	T:rTMS C:假刺激	右侧DLFFC	“8”字形线圈,20 Hz,80% RMT,1600个脉冲,1次/d,5 d/周,共2周	③⑧	0.2	1/2
赵春梅等(2020)^[20]	中国	20/20	27/13	T:29.1±5.60 C:28.9±6.70	T:0.17±0.06 C:0.17±0.06	T:rTMS + 常规治疗 C:假刺激+常规治疗	双侧DLFFC	“8”字形线圈,1 Hz,80% RMT,750个脉冲,1次/d,5 d/周,共4周	②④	无	0/0
周俊香等(2019)^[21]	中国	32/32	31/33	T:41.1±3.70 C:39.5±2.60	T:0.15±0.01 C:0.15±0.02	T:rTMS + 常规治疗 C:常规治疗	额叶或双侧颞叶或枕叶	“8”字形线圈,2 Hz,80% RMT,20 min/次,1次/d,5次/周,共4周	①②	无	0/0
王单等(2016)^[22]	中国	30/30	40/20	T:32.8±8.63 C:31.7±9.32	T:0.10±0.05 C:0.09±0.04	T:rTMS +常规治疗 C:常规治疗	健侧前额叶	“8”字型线圈,1 Hz,80% RMT,1000个脉冲,1次/d,5次/周,共4周	⑥	无	0/0
关晨霞等(2016)^[18]	中国	20/20	30/10	T:47.5±10.10 C:45.3±9.50	T:0.12±0.02 C: 0.12±0.01	T:rTMS+ 常规治疗 C:假刺激+常规治疗	左侧DLFFC	“8”字形线圈,1 Hz,20 min/次,周一至周五2次/d,周六1次/d,共4周	②⑤⑨	无	0/0
黄居科等(2009)^[19]	中国	30/30	39/21	T:45.3±17.08 C:43.9±16.80	T:0.13±0.07 C:0.12±0.07	T:rTMS+ 常规治疗 C:常规治疗	双侧前额叶	“8”字形线圈,0.5 Hz,60% RMT,30次/序列,1个序列/d	①④⑤	无	0/0

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重复经颅磁刺激治疗脑外伤患者认知障碍的Meta分析

Efficacy of Repetitive Transcranial Magnetic Stimulation on Cognitive Dysfunction after Traumatic Brain Injury: A Meta-analysis

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