经颅直流电刺激对帕金森病患者认知功能和生活质量影响的Meta分析

doi:10.3969/j.issn.1006-9771.2024.02.007

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (2): 183-188.doi: 10.3969/j.issn.1006-9771.2024.02.007

经颅直流电刺激对帕金森病患者认知功能和生活质量影响的Meta分析

王铭琛¹, 张文宇¹, 张贤祚², 臧万里³()

1.山东中医药大学第一临床医学院，山东济南市 250014
2.中国科学技术大学附属第一医院骨科，安徽合肥市 230026
3.哈尔滨体育学院研究生院，黑龙江哈尔滨市 150008

收稿日期:2023-10-19 修回日期:2024-01-15 出版日期:2024-02-25 发布日期:2024-03-01
通讯作者: 臧万里 E-mail:wanli19961218@163.com
作者简介:王铭琛(1997-)，男，汉族，河北石家庄市人，硕士研究生，主要研究方向：中医、中西医结合脑病基础及临床研究。
基金资助:
国家自然科学基金项目(82202672)

Effect of transcranial direct current stimulation on cognitive function and quality of life in patients with Parkinson's disease: a meta-analysis

WANG Mingchen¹, ZHANG Wenyu¹, ZHANG Xianzuo², ZANG Wanli³()

1. First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Ji'nan, Shandong 250014, China
2. Department of Orthopedics, First Affiliated Hospital, University of Science and Technology of China, Hefei, Anhui 230026, China
3. Graduate School, Harbin Sport University, Harbin, Heilongjiang 150008, China

Received:2023-10-19 Revised:2024-01-15 Published:2024-02-25 Online:2024-03-01
Contact: ZANG Wanli E-mail:wanli19961218@163.com
Supported by:
National Natural Science Foundation of China(82202672)

摘要/Abstract

摘要：

目的评估经颅直流电刺激(tDCS)对帕金森病患者认知功能和生活质量的影响。
方法检索PubMed、Web of Science、Embase、Cochrane Library、中国知网、中国生物医学文献数据库、维普和万方数据库，纳入有关tDCS治疗帕金森病患者的随机对照试验。对照组接受如普拉克索等常规抗帕金森病药物治疗或tDCS假刺激、理疗、认知康复训练等，治疗组在对照组基础上加用tDCS。检索时间为建库至2023年9月。采用Cochrane偏倚风险评估工具对研究质量进行评价，利用RevMan 5.4和Stata 17.0进行数据合并和分析，并分析异质性和敏感性。
结果共纳入8篇文献。tDCS能够显著提高帕金森病患者蒙特利尔认知评估量表评分(MD = 2.00, 95%CI 1.13~2.87, P < 0.001)，但帕金森病患者生活质量评分(MD = 0.73, 95%CI -5.78~7.23, P = 0.830)、贝克抑郁自评量表评分(MD = -0.77, 95%CI -7.14~5.60, P = 0.810)和统一帕金森病评定量表第三部分评分(MD = 1.60, 95%CI -0.77~3.97, P = 0.190)无显著性变化。
结论 tDCS能促进帕金森病患者认知功能改善。

关键词: 帕金森病, 认知障碍, 经颅直流电刺激, Meta分析

Abstract:

Objective To evaluate the effect of transcranial direct current stimulation (tDCS) on the cognitive function and quality of life in patients with Parkinson's disease.
Methods Randomized controlled trials (RCTs) on tDCS for Parkinson's disease were searched in PubMed, Web of Science, Embase, Cochrane Library, CNKI, CBM, VIP and Wanfang Data from the inception to September, 2023. Control group was administered standard Parkinson's medications or placebo, physical therapy, and cognitive rehabilitation, while treatment group received tDCS additionally. The quality of the researches was evaluated using the Cochrane Risk of Bias Tool. Data synthesis and analysis were performed using RevMan 5.4 and Stata 17.0, with heterogeneity and sensitivity analyses.
Results Eight articles were included. tDCS significantly improved the scores of Montreal Cognitive Assessment (MD = 2.00, 95%CI 1.13 to 2.87, P < 0.001). However, there was no significant difference in the scores of Parkinson's Disease Questionnaire (MD = 0.73, 95%CI -5.78 to 7.23, P = 0.830), Beck Depression Inventory-Ⅱ(MD = -0.77, 95%CI -7.14 to 5.60, P = 0.810), and Unified Parkinson Disease Rating Scale-Ⅲ (MD = 1.60, 95%CI -0.77 to 3.97, P = 0.190).
Conclusion tDCS may improve cognitive function of patients with Parkinson's disease.

Key words: Parkinson's disease, cognitive impairment, transcranial direct current stimulation, meta-analysis

中图分类号:

R742.5

王铭琛, 张文宇, 张贤祚, 臧万里. 经颅直流电刺激对帕金森病患者认知功能和生活质量影响的Meta分析[J]. 《中国康复理论与实践》, 2024, 30(2): 183-188.

WANG Mingchen, ZHANG Wenyu, ZHANG Xianzuo, ZANG Wanli. Effect of transcranial direct current stimulation on cognitive function and quality of life in patients with Parkinson's disease: a meta-analysis[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 183-188.

图/表 5

图1

图2

表1

纳入文献基本特征"

纳入文献	国家	n (C/T)	平均年龄 (C/T)/岁	平均病程 (C/T)	干预措施	干预方案	刺激靶点	刺激部位	结局指标
纳入文献	国家	n (C/T)	平均年龄 (C/T)/岁	平均病程 (C/T)	干预措施	干预方案	刺激靶点	刺激部位	认知功能	生活质量
Manenti等^[19](2016)	意大利	10/10	(69.10±5.60)/ (69.00±9.10)	(7.80±4.20)年/ (7.10±3.60)年	C：①② T：②+tDCS(2 mA)	每次25 min，每天1次，每周5 d，共2周	左侧DLPFC	阳极F3/F4 阴极对侧眼眶上区	-	PDQ-39 BDI-Ⅱ UPDRS-Ⅲ
孙莉等^[22](2020)	中国	11/11	(65.00±12.67)/ (62.00±14.73)	(7.60±3.20)年/ (8.20±3.80)年	C：①③④ T：③④+tDCS (2 mA)	每次40 min，每天1次，每周5 d，共4周	左侧DLPFC	阳极F3/F4 阴极对侧眼眶上部	MoCA	-
朱胜巍^[23](2020)	中国	35/35	(77.11±3.25)/ (77.06±3.23)	(3.95±2.17)年/ (3.62±2.15)年	C：③ T：③+tDCS(2 mA)	每次20 min，每周2~3次，共2个月	左侧DLPFC	阳极F3 阴极右侧眼眶上方	MoCA	-
李学等^[24](2018)	中国	28/28	(64.39±5.50)/ (64.32±5.59)	(1.28±0.56)年/ (1.19±0.57)年	C：① T：tDCS(2 mA)	每次20 min，每天1次，共8周	初级运动皮质(M1)	阳极Cz 阴极双侧眼眶上缘连线中点	MoCA	-
王广君等^[25](2016)	中国	20/20	(62.00±2.30)/ (61.00±2.10)	-	C：③⑤ T：③⑤+tDCS (1 mA)	每次10 min，每天1次，共10 d	左侧DLPFC	阳极F3 阴极对侧眉弓上缘	MoCA	-
胡喜莲等^[26](2021)	中国	49/49	(63.68±5.22)/ (64.23±4.78)	(32.32±12.40)个月/(33.02±10.65)个月	C：③⑤ T：③⑤+tDCS (2 mA)	每次25 min，每2周1次，共12周	左侧或右侧DLPFC	阳极F3/F4 阴极对侧眶上方	MoCA	-
Lawrence等^[27](2018)	澳大利亚	7/7	(72.29±6.21)/ (72.00±6.45)	(5.36±4.14)年/ (5.50±5.66)年	C：①③ T：tDCS (1.5 mA)	每次20 min，每天1次，每周1 d，共1个月	左侧DLPFC	阳极F3 阴极左眼上方	-	PDQ-39
Manenti等^[28](2018)	意大利	11/11	(63.80±7.100)/ (65.50±6.40)	(7.60±3.4)年/ (6.20±3.90)年	C：①③④ T：④+tDCS (2 mA)	每次25 min，每天1次，每周7 d，共2周	左侧DLPFC	阳极F3以上阴极右侧眶上区	-	PDQ-39 BDI-Ⅱ UPDRS-Ⅲ

表1

表2

表3

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结局指标	纳入研究数/n	异质性检验		效应模型	Meta分析结果
结局指标	纳入研究数/n	I²值/%	P值	效应模型	MD(95%CI)	P值
MoCA评分^{[22⇓⇓⇓-26]}	5	66	0.020	随机效应模型	2.00(1.13, 2.87)	< 0.001
病程> 2年^{[22-23,25-26]}	4	40	0.170	固定效应模型	1.59(1.12, 2.06)	< 0.001
PDQ-39评分^[19,27-28]	3	0	0.410	固定效应模型	0.73(-5.78, 7.23)	0.830
BDI-Ⅱ评分^[19,28]	2	65	0.090	随机效应模型	-0.77(-7.14, 5.60)	0.810
UPDRS-Ⅲ评分^[19,28]	2	0	1.000	固定效应模型	1.60(-0.77, 3.97)	0.190

结局指标	研究数量/n	样本量/n	局限性	不一致性
MoCA评分	5	286	0	降一级^a
PDQ-39评分	3	56	0	0
结局指标	间接性	不准确性	发表偏倚	证据等级
MoCA评分	0	降一级^b	降一级^c	极低
PDQ-39评分	0	降一级^b	0	中等

经颅直流电刺激对帕金森病患者认知功能和生活质量影响的Meta分析

Effect of transcranial direct current stimulation on cognitive function and quality of life in patients with Parkinson's disease: a meta-analysis

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