经颅直流电刺激改善卒中后失语的系统综述

doi:10.3969/j.issn.1006-9771.2022.05.008

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (5): 534-543.doi: 10.3969/j.issn.1006-9771.2022.05.008

经颅直流电刺激改善卒中后失语的系统综述

陈雅婷^1,²,张劼²,张优媚³,张双双^1,²,叶祥明²()

1.蚌埠医学院研究生院,安徽蚌埠市 233030
2.浙江省人民医院康复医学科,浙江杭州市 310014
3.浙江中医药大学第三临床医学院,浙江杭州市 310053

收稿日期:2022-02-13 修回日期:2022-04-29 出版日期:2022-05-25 发布日期:2022-06-10
通讯作者: 叶祥明 E-mail:yexmdr@126.com
作者简介:陈雅婷(1994-),女,汉族,湖南常德市人,硕士,医师,主要研究方向：卒中后失语。
基金资助:
浙江省自然科学基金项目(LGF20H170011);浙江省自然科学基金项目(LGF22H170003)

Effects transcranial direct current stimulation on post-stroke aphasia: a systematic review

CHEN Yating^1,²,ZHANG Jie²,ZHANG Youmei³,ZHANG Shuangshuang^1,²,YE Xiangming²()

1. Bengbu Medical University, Bengbu, Anhui 233030, China
2. Zhejiang Provential People's Hospital, Hangzhou, Zhejiang 310014, China
3. Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China

Received:2022-02-13 Revised:2022-04-29 Published:2022-05-25 Online:2022-06-10
Contact: YE Xiangming E-mail:yexmdr@126.com
Supported by:
Zhejiang Natural Science Foundation(LGF20H170011);Zhejiang Natural Science Foundation(LGF22H170003)

摘要/Abstract

摘要：

目的系统评价经颅直流电刺激(tDCS)对卒中后失语症(PSA)的治疗作用。方法在PubMed、Web of Science、Cochrane Library、Embase、中国知网和万方数据库中检索tDCS治疗卒中后失语的相关文献,检索时间为建库至2021年12月。提取相关内容进行系统综述。结果共返回文献1 026篇,最终纳入45篇,发表时间为2010年至2021年,研究对象为卒中后失语患者,主要结局指标为言语量表和各子项。大部分研究治疗组治疗后言语量表评分高于对照组,少数波士顿失语症检查中未见改善,或仅复杂语言任务有改善。tDCS能改善卒中后失语患者的复述、命名、拼写、言语流畅度等。影响患者恢复的因素可能有电极位置、电流、持续时间、强度和左侧皮质完整性。结论 tDCS治疗PSA对不同语言子项均有效果;不同tDCS方案对不同语言功能的效果有所差异。

关键词: 脑卒中, 失语, 经颅直流电刺激, 系统综述

Abstract:

Objective To evaluate the effects of transcranial direct current stimulation (tDCS) on post-stroke aphasia (PSA). Methods Literatures about tDCS for PSA were retrieved from PubMed, Web of Science, Cochrane library, Embase CNKI and Wanfang Data, until December, 2021. The contents of the author, publication time, subjects, intervention methods and time, main outcome indicators and conclusions were extracted. Results A total of 1 026 articles were returned and 45 articles were finally included. The publication time was from 2010 to 2021. The subjects of the study were patients with PSA. The main outcome indicators were the various speech scales and their sub-items. For most of the trials, scores of the scales were better in the experimental groups than in the control groups after treatment, and a few found little improvement in Boston Diagnostic Aphasia Examination, or only improved in complex language tasks. tDCS can improve the repetition, naming, spelling and verbal fluency of PSA patients, which might relate with electrode placement, current magnitude, duration, intensity and left cortical integrity. Conclusion tDCS is effective on different language sub-items of PSA, and various with the program of tDCS.

Key words: stroke, aphasia, transcranial direct current stimulation, systematic review

中图分类号:

R743.3

陈雅婷,张劼,张优媚,张双双,叶祥明. 经颅直流电刺激改善卒中后失语的系统综述[J]. 《中国康复理论与实践》, 2022, 28(5): 534-543.

CHEN Yating,ZHANG Jie,ZHANG Youmei,ZHANG Shuangshuang,YE Xiangming. Effects transcranial direct current stimulation on post-stroke aphasia: a systematic review[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(5): 534-543.

图/表 4

图1

表1

纳入文献的一般情况"

研究	刺激电极	刺激部位	评估工具	结果
Branscheidt等^[16](2018)	阳极	左初级运动皮质	词汇决策任务,简单反应时间任务	提高词汇判断的准确率
Campana等^[13](2015)	阳极	左额下回	语言测验	疗效取决于左侧皮质解剖完整性
Cherney等^[17](2021)	阳极/阴极	个性化刺激部位	西方失语成套测验,交际有效性指数	促进语言皮质激活
Cipollari等^[18](2015)	阳极	右额下回	西方失语成套测验	言语功能改善
Darkow等^[9](2017)	阳极	左初级运动皮质	独立成分分析	增强命名网络的活动性和连通性
Feil等^[19](2019)	阳极	双额下回	学习适应性测验/标记测验	图片命名改善(名词数量增加)
Fiori等^[20](2013)	阳极	左额下回/左Wernicke	标记测验	颞区名词命名改善明显,额区动词命名改善明显
Fiori等^[21](2019)	阴极	右额下回Broca同源区	动词检索任务	2 mA组动词命名改善
Flöel等^[22](2011)	阳极/阴极	右颞顶皮质	学习适应性测验	命名能力提高
Fridriksson等^[23](2018)	阳极	左具有最高命名相关激活性的颞叶区域(Wernicke区附近)	费城命名量表	命名正确率提高
Guillouët等^[24](2020)	阳极/阴极	双额下回	波士顿诊断性失语症检查(法语改编版)	没有明显改善
Ihara等^[25](2020)	阳极	左额下回	命名任务+造句任务	命名正确率、未训练词的相关词句的产生改善
Kang等^[26](2011)	阴极	右额下回	波士顿诊断性失语症检查	图片命名改善
Keser等^[27](2017)	阳极	右额下回	西方失语成套测验	言语和语言能力改善
Kurfeß等^[28](2020)	阳极	左额下回	命名测验	组间无显著性差异
Marangolo等^[29](2013)a	阳极	左额下回/左Wernicke区	标记测验,名词和动词命名	改善信息性言语
Marangolo等^[30](2013)b	阳极	左额下回/左Wernicke区	标记测验,波士顿诊断性失语症检查	促进动词提取缺陷恢复
Marangolo等^[31](2014)	阳极/阴极	双额下回	图片描述,名词和动词命名	图片描述、名词和动词命名恢复
Marangolo等^[11](2016)	阳极/阴极	双额下回(左阳极,右阴极)	图片描述任务,名词和单词重复	增加受损半球的功能连接,促进言语功能恢复
Marangolo等^[32](2018)	阴极	右小脑	动词命名/生成任务	复杂的语言任务改善
Meinzer等^[33](2016)	阳极	左初级运动皮质	合作伙伴沟通问卷	命名改善,效果持续
Monti等^[34](2008)	阳极/阴极	左额下回	图片命名任务	图片命名任务准确率提高
Norise等^[35](2017)	阳极/阴极	左额颞叶	改良波士顿诊断性失语症检查	单词水平流利度提高
Pestalozzi等^[36](2018)	阳极/假刺激	左DLPFC	波士顿诊断性失语症检查,失语障碍量表	词汇提取加工改善
Pisano等^[37](2021)	阳极/阴极	双颞顶皮质	语言测验	写作能力改善
Polanowska等^[38](2013)a	阳极	左额下回后部	波士顿诊断性失语症检查	组间无显著性差异
Polanowska等^[39](2013)b	阳极	左额下回	波士顿诊断性失语症检查	组间无显著性差异
Richardson等^[40](2015)	阳极/阴极	功能影像定位	命名准确性和响应时间	命名准确率和响应时间提高
Shah-Basak等^[41](2015)	阳极/阴极	双前额叶	西方失语成套测验	图片命名改善
Shah-Basak等^[42](2020)	阳极/阴极	个性化刺激部位	西方失语成套测验,波士顿诊断性失语症检查,图片词汇测试,延迟单词阅读任务	复述准确率提高
Silva等^[43](2018)	阴极	右额下回	波士顿诊断性失语症检查,命名测验	策略正确响应平均时间降低
Spielmann等^[44](2018)a	阳极	左额下回/左颞上回后部	训练/未训练项目命名准确性	言语功能分提高
Spielmann等^[45](2018)b	阳极	左额下回	波士顿诊断性失语症检查,失语症严重程度评定量表,日常语言测试,标记测验	组间无显著差异
Vila-Nova等^[47](2019)	阳极	左额下回	图片命名任务,音节重复测试	发音准确度提高
Volpato等^[48](2013)	阳极	左额下回	学习适应性测验,物品和动词命名评估	未见显著改善
You等^[49](2011)	阳极/阴极	双颞上回后部	西方失语成套测验	听理解改善
Zhao等^[50](2021)	阳极	左额下回	西方失语成套测验	失语商增加
陶媛媛等^[46](2019)	阳极	左额下回	西方失语成套测验	视觉和听觉通道的命名能力改善
魏雅萍等^[51](2016)	阳极/假刺激	左Broca或Wernicke区	图片命名	图命名准确率提高
方翠霓等^[52](2017)	阳极	左Broca或Wernicke区	改良波士顿诊断性失语症检查,日常生活交流能力检查量表	语言能力改善
张芹等^[53](2017)	阳极/假刺激	左Broca区	图片命名,西方失语成套测验	言语流畅度和命名能力提高
张洪等^[54](2017)	阳极/假刺激	左额下回三角部区阳极刺激、右额下回三角部区阴极刺激	西方失语成套测验	自发言语、复述、命名成绩提高
汪洁等^[55](2018)	阳极	左Broca或Wernicke区	图片命名	治疗项、非治疗项图命名成绩均有改善
王玲等^[56](2018)	阳极	左大脑Broca区	西方失语成套测验	失语商提高,言语功能改善,且存在持续效应
潘巍一等^[57](2021)	阳极	左大脑Broca区	改良波士顿诊断性失语症检查	语言功能恢复,运动性失语改善

表1

表2

图2

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研究	1	2	3	4	5	总偏倚	研究	1	2	3	4	5	总偏倚
Branscheidt等^[16](2018)	+	+	+	+	±	±	Pestalozzi等^[36](2018)	±	+	+	+	+	±
Campana等^[13](2015)	±	±	+	+	+	±	Pisano等^[37](2021)	±	+	+	+	+	±
Cherney等^[17](2021)	+	+	+	+	+	+	Polanowska等^[38](2013)a	±	+	+	+	+	±
Cipollari等^[18](2015)	±	±	+	+	+	±	Polanowska等^[39](2013)b	±	+	+	+	+	±
Darkow等^[9](2017)	±	+	+	+	+	±	Richardson等^[40](2015)	±	+	+	+	+	±
Feil等^[19](2019)	+	+	+	+	+	+	Shah-Basak等^[41](2015)	±	±	±	+	+	±
Fiori等^[20](2013)	±	+	+	+	+	±	Shah-Basak等^[42](2020)	±	+	+	+	+	±
Fiori等^[21](2019)	+	+	+	+	+	+	Silva等^[43](2018)	±	±	+	+	+	±
Flöel等^[22](2011)	±	+	+	+	+	±	Spielmann等^[44](2018)a	±	+	+	+	+	±
Fridriksson等^[23](2018)	+	+	+	+	+	+	Spielmann等^[45](2018)b	±	+	+	+	+	±
Guillouët等^[24](2020)	±	+	+	+	+	±	Vila-Nova等^[47](2019)	±	+	+	+	+	±
Ihara等^[25](2020)	±	+	+	+	±	±	Volpato等^[48](2013)	-	±	+	+	+	-
Kang等^[26](2011)	+	+	+	+	+	+	You等^[49](2011)	±	+	+	+	+	±
Keser等^[27](2017)	±	+	+	+	+	±	Zhao等^[50](2021)	+	+	+	+	+	+
Kurfeß等^[28](2020)	±	+	+	+	+	±	陶媛媛等^[46](2019)	±	±	+	+	+	±
Marangolo等^[29](2013)a	±	+	+	+	+	±	魏雅萍等^[51](2016)	+	+	+	+	±	+
Marangolo等^[30](2013)b	+	+	+	+	+	+	方翠霓等^[52](2017)	+	+	+	+	±	+
Marangolo等^[31](2014)	±	+	+	+	+	±	张芹等^[53](2017)	±	±	+	±	+	±
Marangolo等^[11](2016)	±	+	+	+	+	±	张洪等^[54](2017)	+	+	+	+	±	+
Marangolo等^[32](2018)	±	±	+	±	+	±	汪洁等^[55](2018)	+	+	+	±	±	±
Meinzer等^[33](2016)	±	+	+	+	+	±	王玲等^[56](2018)	+	+	+	+	±	+
Monti等^[34](2008)	±	+	+	+	+	±	潘巍一等^[57](2021)	±	+	+	+	±	+
Norise等^[35](2017)	±	±	+	+	+	±

经颅直流电刺激改善卒中后失语的系统综述

Effects transcranial direct current stimulation on post-stroke aphasia: a systematic review

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