《中国康复理论与实践》

《中国康复理论与实践》 ›› 2026, Vol. 32 ›› Issue (6): 631-644.doi: 10.3969/j.issn.1006-9771.2026.06.002

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间歇性θ脉冲刺激改善脑卒中患者下肢运动和平衡功能的Meta分析

李欣源1,2, 郑洁皎1,2(), 张廷宇3,4, 吴雪娇5, 梁晓笑6   

  1. 1 复旦大学附属华东医院， 上海市 200040
    2 上海中医药大学康复医学院， 上海市 201203
    3 四川大学华西医院康复医学中心/康复医学研究所， 四川成都市 610041
    4 康复医学四川省重点实验室， 四川成都市 610041
    5 上海市第一康复医院， 上海市 200082
    6 复旦大学附属中山医院康复医学科， 上海市 200032
  • 收稿日期:2025-08-05 修回日期:2026-01-26 出版日期:2026-06-25 发布日期:2026-06-24
  • 通讯作者: 郑洁皎，E-mail： zjjcss@163.com
  • 作者简介:李欣源(2000-)，女，汉族，云南陆良县人，硕士研究生，主要研究方向：老年康复、跌倒预防。
    郑洁皎(1953-)，女，汉族，上海市人，教授，主要研究方向：老年康复、康复管理。
  • 基金资助:
    上海市科委"科技创新行动计划"医学创新研究专项重大疑难疾病诊疗方案(策略)临床研究(22Y31900200)

Effect of intermittent theta burst stimulation on lower extremity motor function and balance function in stroke patients: a meta-analysis

LI Xinyuan1,2, ZHENG Jiejiao1,2(), ZHANG Tingyu3,4, WU Xuejiao5, LIANG Xiaoxiao6   

  1. 1 Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
    2 School of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
    3 Rehabilitation Medicine Center/Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
    4 Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
    5 The First Rehabilitation Hospital in Shanghai, Shanghai 200082, China
    6 Department of Rehabilitation Medicine, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China
  • Received:2025-08-05 Revised:2026-01-26 Published:2026-06-25 Online:2026-06-24
  • Contact: ZHENG Jiejiao, E-mail： zjjcss@163.com
  • Supported by:
    Shanghai Science and Technology Commission Science and Technology Innovation Action Plan Clinical Research on Diagnosis and Treatment Plan(Strategy)for Major Difficult Diseases(22Y31900200)

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摘要：

目的 系统评价间歇性θ脉冲刺激(iTBS)对脑卒中患者下肢运动和平衡功能的效果。
方法 计算机检索Cochrane Library、Embase、PubMed、Web of Science、中国知网、中国生物医学数据库、万方数据库和维普，纳入比较iTBS与常规治疗或安慰性iTBS治疗脑卒中后下肢运动和平衡功能障碍患者的随机对照试验。检索时限为建库至2025年2月19日。采用Cochrane偏倚风险评估工具对纳入文献进行质量评价，采用RevMan 5.4和Stata 14.0进行Meta分析。
结果 共纳入16项研究，涉及647例患者。Meta分析结果显示，iTBS能够提高脑卒中患者的Fugl-Meyer评定量表下肢部分评分(MD=2.58, 95%CI 1.61~3.55, P<0.001)、Berg平衡量表评分(MD=4.11, 95%CI 2.43~5.79, P<0.001)、Barthel指数评分(MD=4.95, 95%CI 0.97~8.92, P=0.010)，缩短运动诱发电位潜伏期(MD=-1.42, 95%CI -2.54~-0.30，P=0.010)。亚组分析显示，亚急性期、小脑iTBS、刺激次数>10次，单日脉冲1 200次效果可能更好。
结论 iTBS可改善脑卒中患者下肢运动功能和日常生活活动能力，并缩短MEP潜伏期，在改善平衡功能方面可能具有一定潜在获益。

关键词: 脑卒中, 间歇性θ脉冲刺激, 下肢, 运动功能, 平衡, 康复, Meta分析

Abstract:

Objective To systematically evaluate the effect of intermittent theta burst stimulation(iTBS)on lower extremity motor function and balance function in patients with stroke.
Methods A systematic literature search was conducted in the Cochrane Library, Embase, PubMed, Web of Science, CNKI, SinoMed, Wanfang data and VIP from inception to February 19, 2025. Randomized controlled trials comparing iTBS with conventional rehabilitation or sham iTBS in patients with post-stroke lower extremity motor and balance dysfunction were included. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias Tool. Meta-analysis was performed using RevMan 5.4 and Stata 14.0.
Results A total of 16 articles involving 647 patients were included. Meta-analysis showed that iTBS improved the Fugl-Meyer Assessment-Lower Extremities score(MD=2.58, 95%CI 1.61 to 3.55, P<0.001), Berg Balance Scale score(MD=4.11, 95%CI 2.43 to 5.79, P<0.001), Barthel Index score(MD=4.95, 95%CI 0.97 to 8.92, P=0.010)and motor-evoked potential(MEP)latency(MD=-1.42, 95%CI -2.54 to -0.30, P=0.010). Subgroup analyses suggested that at subacute stage, cerebellar iTBS, more than ten treatment sessions, and 1 200 pulses per day may be more effective.
Conclusion iTBS may improve lower extremity motor function and activities of daily living in patients with stroke, and shorten MEP latency, and it may also confer potential benefits in improving balance function in these patients.

Key words: stroke, intermittent theta burst stimulation, lower extremity, motor function, balance, rehabilitation, meta-analysis

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