非侵入性脑刺激技术改善脑卒中后平衡功能的网状Meta分析

doi:10.3969/j.issn.1006-9771.2026.08.004

《中国康复理论与实践》 ›› 2026, Vol. 32 ›› Issue (8): 903-915.doi: 10.3969/j.issn.1006-9771.2026.08.004

非侵入性脑刺激技术改善脑卒中后平衡功能的网状Meta分析

闫嘉铮¹, 罗小琴¹, 刘日华¹, 于瀛², 亓丰学¹()

¹ 北京体育大学竞技体育学院运动与脑科学实验室，北京市 100084
² 山东大学体育学院，山东济南市 250100

收稿日期:2026-04-07 修回日期:2026-06-17 接受日期:2026-06-23 出版日期:2026-08-25 发布日期:2026-08-25
通讯作者: 亓丰学，E-mail： fengxue.qi@hotmail.com
作者简介:闫嘉铮(2002-)，男，满族，安徽太和县人，硕士研究生，主要研究方向：脑刺激与运动表现提升、运动与脑功能促进。
亓丰学(1985-)，男，博士，副教授，博士研究生导师，主要研究方向：神经调控与运动表现提升、神经调控与脑健康、运动与脑功能促进。
基金资助:
中央高校基本科研业务费专项资金资助课题/运动康复教育部重点实验室(2025KYPT12);北京体育大学高层次人才科研启动项目(3101037)

Non-invasive brain stimulation techniques for balance function after stroke: a network meta-analysis

Yan Jiazheng¹, Luo Xiaoqin¹, Liu Rihua¹, Yu Ying², Qi Fengxue¹()

¹ Sports, Exercise and Brain Sciences Laboratory, Beijing Sport University, Beijing 100084, China
² School of Physical Education, Shandong University, Ji'nan, Shandong 250100, China

Received:2026-04-07 Revised:2026-06-17 Accepted:2026-06-23 Published:2026-08-25 Online:2026-08-25
Contact: Qi Fengxue，E-mail： fengxue.qi@hotmail.com
Supported by:
Fundamental Research Funds for the Central Universities/the Laboratory of Exercise Rehabilitation Science(2025KYPT12);Research Foundation for Advanced Talents of Beijing Sport University(3101037)

摘要/Abstract

摘要：

目的采用网状Meta分析系统对比不同非侵入性脑刺激(NIBS)技术对脑卒中患者平衡功能的干预疗效。

方法系统检索PubMed、Embase、Web of Science、Cochrane Library、Scopus、中国知网数据库，检索时限自建库至2026年2月，纳入探究NIBS改善脑卒中平衡功能的随机对照试验(RCT)和随机交叉试验(RCD)。采用Cochrane偏倚风险评估工具进行偏倚风险评价；采用RevMan 5.4进行敏感性分析；采用Stata 18.0进行亚组分析和网状Meta分析。

结果最终纳入35项研究(31项RCT、4项RCD)，涉及1 226例患者。网状Meta结果显示，各类NIBS对计时起立行走测试结局无显著改善效应；经颅直流电刺激(tDCS)改善Berg平衡量表疗效排序最优(SUCRA = 85.9%)。亚组分析提示，病程≤ 6个月、刺激靶点为初级运动皮质、磁刺激参数80%~100% RMT的干预方案平衡获益更显著。

结论 tDCS改善脑卒中患者综合平衡功能的疗效最优，可作为脑卒中平衡康复的辅助干预手段。

关键词: 脑卒中, 非侵入性脑刺激, 平衡功能, 网状Meta分析

Abstract:

Objective To systematically compare the efficacy of different non-invasive brain stimulation (NIBS) techniques on balance function in stroke patients via network meta-analysis.

Methods PubMed, Embase, Web of Science, Cochrane Library, Scopus and CNKI were systematically searched from database establishment to February, 2026. Randomized controlled trials (RCTs) and randomized crossover designs (RCDs) investigating NIBS for post-stroke balance impairment were enrolled. The Cochrane risk of bias assessment tool was used for risk-of-bias assessment; RevMan 5.4 was used for sensitivity analysis, and Stata 18.0 for subgroup analysis and network meta-analysis.

Results A total of 35 eligible studies (31 RCTs, 4 RCDs) involving 1 226 stroke patients were included. No NIBS modalities might significantly improve the outcome of Timed Up and Go Test, while the effect of transcranial direct current stimulation (tDCS) ranked first on Berg Balance Scale score (SUCRA = 85.9%). Subgroup analyses indicated superior balance benefits in interventions targeting primary motor cortex, with stimulation intensity of 80% to 100% RMT and disease courses ≤ 6 months.

Conclusion tDCS may be an optimal intervention for comprehensive balance function after stroke.

Key words: stroke, non-invasive brain stimulation, balance, network meta-analysis

中图分类号:

R743.3

闫嘉铮, 罗小琴, 刘日华, 于瀛, 亓丰学. 非侵入性脑刺激技术改善脑卒中后平衡功能的网状Meta分析[J]. 《中国康复理论与实践》, 2026, 32(8): 903-915.

Yan Jiazheng, Luo Xiaoqin, Liu Rihua, Yu Ying, Qi Fengxue. Non-invasive brain stimulation techniques for balance function after stroke: a network meta-analysis[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(8): 903-915.

图/表 13

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纳入文献基本特征"

纳入文献	样本量/n		年龄/岁		刺激强度	刺激靶点	病程		干预措施		结局指标
纳入文献	C	T	C	T	刺激强度	刺激靶点	C	T	C	T	结局指标
Qurat-ul-ain等^[32](2023)	22	22 22	57.95±5.45	59.00±4.61 55.77±6.30	2 mA	小脑 M1	(16.41±10.26)个月	(16.50±11.80)个月 (11.23±7.73)个月	d	a	①③④
Da Cunha等^[33](2022)	16	16	58.25±9.75	55.44±8.47	2 mA	M1	≥ 6个月	≥ 6个月	e	a	①
Ehsani等^[34](2022)	11	12	61.90±5.84	62.33±7.02	2 mA	M1	(134.56±4.10) d	(140.50±4.20) d	d	a	③
Haleem等^[35](2025)	22	22	56.41±4.04	57.18±4.66	2 mA	M1	(3.23±1.54)个月	(4.00±1.19)个月	e	a	③
Kim等^[36](2024)	12	12	58.50±16.41	62.58±11.22	2 mA	M1	(45.83±25.94)个月	(59.17±58.92)个月	e	a	①②③
Klomjai等^[37](2022)	10	9	57.20±2.80	58.60±2.60	2 mA	M1		(3.30±0.50)个月	e	a	①
Manji等^[38](2018)	15	15	63.70±11.00	62.20±10.10	1 mA	SMA	(149.70±24.20) d	(134.50±55.70) d	e	a	①
Qurat-ul-ain等^[39](2022)	22	22 22	58.36±5.90	56.18±6.30 57.91±5.75	2 mA	小脑 M1	(18.18±13.10)个月	(17.63±13.75)个月 (10.45±9.30)个月	e	a	①③④
Saeys等^[40](2015)	15	16	64.53±7.23	62.00±9.61	1.5 mA	M1	(38.40±15.14) d	(45.50±21.80) d	4周e 4周b	4周a 4周e	⑤
Seo等^[41](2017)	10	11	62.90±8.90	61.10±8.90	2 mA	M1	(152.50±122.80)个月	(75.50±83.40)个月	e	a	③
Sha等^[42](2021)	10	10^* 10^#	> 18	> 18	2 mA	M1	—	—	e	a	③
Shakeb等^[43](2024)	18	18	58.00±9.16	54.38±7.45	2 mA	M1	(4.97±0.81)个月	(4.88±1.01)个月	e	a	①②
Utarapichat等^[44](2018)	5	5	57.10±12.20	57.10±12.20	2 mA	M1	—	(34.10±18.90)个月	先e 后b	先a 后e	①
Wang等^[45](2024)	40	42	61.94±3.28	63.16±5.75	2 mA	M1	(18.89±5.17) d	(20.05±4.28) d	e	a	①③
Zandvliet等^[46](2018)	10	15	57.90±7.10	57.10±10.00	1.5 mA	小脑	—	(107.80±143.60)个月	优势侧b +优势侧e	对侧a+同侧a+对侧e	⑥
Forogh等^[47](2017)	7	8	53.00~79.00	53.00~79.00	—	M1	> 6个月	> 6个月	e	b	③
Lin等^[48](2015)	15	16	62.30±11.70	58.30±10.80	100%RMT	M1	(33.50±23.80) d	(40.60±29.10) d	e	b	⑤
Ma等^[49](2024)	36	37	65.83±8.45	68.62±10.67	90% RMT	M1	1~7 d	1~7 d	d	b	①
Rastgoo等^[50](2016)	10	10	49.70±11.00	54.60±11.75	90% RMT	M1	(27.40±20.10)个月	(30.20±18.30)个月	先e 后b	先b 后e	①
Wang等^[51](2024)	20	27	60.34±6.07	60.95±4.11	90% RMT	M1	(15.86±6.59) d	(12.37±6.15) d	d	b	③
Wang等^[52](2024)	16	16	47.94±18.39	52.38±11.94	100%RMT	M1	(8.47±7.88)个月	(8.50±7.74)个月	e	b	③
Yu等^[53](2022)	9	9	57.37±12.78	54.60±11.83	80% RMT	DLPFC	(1.34±0.27)个月	(1.01±0.32)个月	d	b	①③
Zhao等^[54](2024)	18	18 18	58.11±8.11	57.78±8.72 57.89±7.81	100%RMT	M1 SMA	(29.33±22.08) d	(27.78±19.18) d (33.22±19.18) d	d	b	③
Liao等^[55](2024)	12	12 12	57.08±11.28	57.17±11.63 58.25±14.63	80% RMT	小脑 M1	(52.50±38.52) d	(53.33±34.73) d (72.00±67.13) d	e	c	③
Xie等^[56](2021)	18	18	54.41±7.01	52.35±8.62	80% AMT	小脑	(2.91±1.96)个月	(2.22±1.70)个月	e	c	①
Zhu等^[57](2024)	18	18	62.33±8.78	58.67±7.24	80% AMT	小脑	(52.00±48.56) d	(61.89±46.72) d	e	c	①③
Xia等^[58](2022)	9	11 11	54.44±14.21	50.36±8.99 47.18±11.98	100%RMT	SMA M1	(49.00±25.00) d	(50.00±13.00) d (50.00±17.00) d	c	c	⑥
Liao等^[59](2021)	15	15	55.40±8.10	51.53±9.22	80% AMT	小脑	(86.53±45.26) d	(70.40±44.43) d	e	c	③
Koch等^[60](2019)	18	18	65.00±12.00	63.00±11.00	80% AMT	小脑		> 6个月	e	c	③
Xiao等^[61](2024)	24	25	54.00±13.00	53.90±14.90	80% RMT	M1	(42.30±24.30) d	(51.40±19.40) d	d	b	③
Toktas等^[62](2024)	14	14	62.57±8.53	58.79±10.19	2 mA	M1	(6.86±3.08)个月	(8.07±5.37)个月	d	a	①③
Zhang等^[63](2024)	14	13	59.86±9.45	56.15±10.43	90% RMT	M1	(2.50±1.83)个月	(2.73±1.73)个月	d	b	③
Fang等^[64](2025)	18	18	57.00±12.61	58.67±9.91	90% RMT	M1		1~6个月	d	b	③
Goel等^[65](2024)	16	16	58.67±9.14	55.94±8.39	2 mA	M1		≥6个月	d	a	①②
Lin等^[66](2019)	10	10	61.10±9.70	60.80±8.10	—	M1		> 6个月	e	c	①③

表3

表4

表5

图3

表6

表7

图4

表8

表9

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人群(Population)	干预(Intervention)	比较(Comparison)	结局(Outcome)
脑卒中患者	干预形式：TMS、tDCS、tACS、rTMS、TBS、tRNS	与常规康复训练、伪刺激比较	平衡功能
	干预方案：干预周期、刺激频率、干预时长	不同刺激技术比较	综合平衡功能
			静态平衡功能
			动态平衡功能

类型	参数
tDCS	强度1~2 mA 时间10~30 min
tACS	强度< 4 mA 频率：β波多为20 Hz、γ波多为40 Hz 时间10~30 min
rTMS	强度80%~120% MT 频率：低频< 1 Hz，高频5~20 Hz 时间15~40 min
iTBS	强度：80%~120% RMT或80% AMT 频率< 50 Hz 时间3~10 min
tRNS	强度1~2 mA 频率0.1~640 Hz 时间10~30 min

亚组		纳入研究数/n	样本量/n	I²/%	Meta分析结果
亚组		纳入研究数/n	样本量/n	I²/%	SMD(95%CI)	P值
靶点	小脑	6项^{[32,39,55,57,59-60]}	214	92.1	0.32(0.03~0.62)	0.031
靶点	M1	18项^{[32,34-36,39,41-42,45,47,51-52,54-55,61-64,66]}	616	78.5	0.51(0.34~0.68)	< 0.001
强度	≤ 2 mA	9项^{[32,34-36,39,41-42,45,62]}	374	69.9	0.04(-0.16~0.23)	0.720
	80%~100% RMT	8项^{[51-55,61,63-64]}	299	83.4	0.97(0.73~1.21)	< 0.001
	80% AMT	3项^[57,59-60]	102	87.3	0.89(0.46~1.31)	< 0.001
病程	> 6个月	9项^{[32,36,39,41,47,52,60,62,66]}	308	81.4	0.05(-0.17~0.27)	0.671
病程	≤ 6个月	12项^{[34-35,45,51,53-55,57,59,61,63-64]}	482	80.8	0.74(0.55~0.93)	< 0.001
干预方式	tDCS	9项^{[32,34-36,39,41-42,45,62]}	374	69.9	0.04(-0.16~0.23)	0.720
	rTMS	8项^{[47,51-54,61,63-64]}	278	49.1	0.79(0.55~1.03)	< 0.001
	iTBS	5项^{[55,57,59-60,66]}	158	91.3	1.11(0.75~1.47)	<0.001

亚组		纳入研究数/n	样本量/n	I²/%	Meta分析结果
亚组		纳入研究数/n	样本量/n	I²/%	SMD(95%CI)	P值
靶点	小脑	4项^{[32,39,56-57]}	160	69.4	0.39(0.07~0.71)	0.017
靶点	M1	13项^{[32-33,36-37,39,43-45,49-50,62,65-66]}	464	81.8	-0.10(-0.29~0.09)	0.285
干预参数	≤ 2mA	11项^{[32-33,36-39,43-45,62,65]}	425	84.8	0.08(-0.11~0.27)	0.405
	80%~100% RMT	3项^[49-50,53]	111	0.0	-0.18(-0.56~0.19)	0.336
	80%AMT	2项^[56-57]	72	10.0	-0.12(-0.58~0.35)	0.629
病程	> 6个月	9项^{[32-33,36,39,44,50,62,65-66]}	298	83.8	0.33(0.10~0.55)	0.005
病程	≤ 6个月	8项^{[37-38,43,45,49,53,56-57]}	330	0.0	-0.28(-0.49~-0.06)	0.013
干预方式	tDCS	11项^{[32-33,36-39,43-45,62,65]}	425	84.8	0.08(-0.11~0.27)	0.405
	rTMS	3项^[49-50,53]	111	0.0	-0.18(-0.56~0.19)	0.336
	iTBS	3项^[56-57,66]	92	0.0	-0.05(-0.46~0.37)	0.830

组别	SMD	95%CI
rTMS vs. tDCS	0.24	-1.80~2.28
iTBS vs. tDCS	-0.17	-2.17~1.83
常规康复 vs. tDCS	1.03	-0.44~2.50
伪刺激 vs. tDCS	-0.01	-1.03~1.01
iTBS vs. rTMS	-0.41	-3.10~2.28
常规康复 vs. rTMS	0.79	-1.02~2.60
伪刺激 vs. rTMS	-0.25	-2.32~1.82
常规康复 vs. iTBS	1.20	-1.21~3.62
伪刺激 vs. iTBS	0.16	-1.56~1.88
伪刺激 vs. 常规康复	-1.04	-2.74~0.65

非侵入性脑刺激技术改善脑卒中后平衡功能的网状Meta分析

Non-invasive brain stimulation techniques for balance function after stroke: a network meta-analysis

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组别	SMD	95%CI
rTMS vs. tDCS	-0.45	-1.59~0.68
iTBS vs. tDCS	-0.25	-1.42~0.92
常规康复 vs. tDCS	-1.65	-2.62~-0.68
伪刺激 vs. tDCS	-1.17	-1.97~-0.37
iTBS vs. rTMS	0.20	-1.31~1.71
常规康复 vs. rTMS	-1.20	-1.95~-0.44
伪刺激 vs. rTMS	-0.72	-1.97~0.53
常规康复 vs. iTBS	-1.40	-2.83~0.04
伪刺激 vs. iTBS	-0.92	-1.78~-0.06
伪刺激 vs. 常规康复	0.48	-0.67~1.63

剔除研究	SMD	95%CI	P值	I²/%
未剔除	-0.03	-0.37~0.31	0.88	77
Qurat-ul-ain等小脑组^[32]	-0.07	-0.42~0.28	0.69	77
Qurat-ul-ain等M1组^[32]	-0.03	-0.39~0.33	0.87	79
Da Cunha等^[33]	-0.06	-0.41~0.30	0.75	78
Eunmi等^[36]	-0.06	-0.41~0.29	0.73	78
Wanalee等^[37]	-0.04	-0.40~0.31	0.81	79
Manji等^[38]	-0.01	-0.36~0.35	0.97	78
Qurat-ul-ain等小脑组^[39]	-0.08	-0.42~0.26	0.64	76
Qurat-ul-ain等M1组^[39]	-0.07	-0.42~0.28	0.69	71
Shakeb等^[43]	-0.02	-0.38~0.34	0.90	79
Utarapichat等^[44]	-0.03	-0.38~0.32	0.87	79
Wang等^[45]	-0.02	-0.32~0.37	0.90	75
Ma等^[49]	-0.02	-0.38~0.35	0.93	78
Rastgoo等^[50]	-0.03	-0.38~0.33	0.88	79
Yu等^[53]	-0.03	-0.38~0.33	0.88	79
Xie等^[56]	-0.01	-0.37~0.35	0.96	78
Zhu等^[57]	-0.04	-0.40~0.32	0.83	79
Toktas等^[62]	-0.04	-0.40~0.31	0.81	79
Goel等^[65]	-0.12	-0.12~0.36	0.33	53
Lin等^[66]	-0.04	-0.39~0.32	0.83	79

剔除研究	SMD	95%CI	P值	I²/%
未剔除	0.59	0.25~0.93	< 0.001	82
Qurat-ul-ain等^[32]小脑组	0.64	0.30~0.98	< 0.001	81
Qurat-ul-ain等M1^[32]组	0.61	0.26~0.97	< 0.001	83
Ehsani等^[34]	0.58	0.23~0.93	0.001	83
Haleem等^[35]	0.62	0.27~0.98	< 0.001	83
Kim等^[36]	0.62	0.27~0.97	< 0.001	83
Qurat-ul-ain等小脑组^[39]	0.64	0.30~0.98	< 0.001	81
Qurat-ul-ain等M1组^[39]	0.65	0.31~0.98	< 0.001	81
Seo等^[41]	0.61	0.26~0.97	< 0.001	83
Sha等^[42]	0.59	0.23~0.94	0.001	83
WANG等^[45]	0.59	0.23~0.95	0.001	83
Forogh等^[47]	0.59	0.24~0.94	0.001	83
Wang等^[51]	0.54	0.20~0.87	0.002	81
Wang等^[52]	0.58	0.23~0.93	0.001	83
Yu等^[53]	0.60	0.24~0.95	< 0.001	83
Zhao等M1组^[54]	0.55	0.21~0.90	0.002	82
Zhao等SMA组^[54]	0.61	0.25~0.96	< 0.001	83
Liao等小脑组^[55]	0.50	0.17~0.82	0.003	80
Liao等M1组^[55]	0.59	0.17~0.80	0.003	79
Zhu等^[57]	0.61	0.25~0.96	< 0.001	83
Liao等^[59]	0.59	0.24~0.95	0.001	83
Koch等^[60]	0.51	0.18~0.84	0.002	80
Xiao等^[61]	0.60	0.24~0.96	0.001	83
Toktas等^[62]	0.60	0.25~0.96	< 0.001	83
Zhang等^[63]	0.60	0.25~0.95	< 0.001	83
Fang等^[64]	0.59	0.23~0.94	0.001	83
Lin等^[66]	0.62	0.26~0.97	< 0.001	83

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