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

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%CI0.98~2.86,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。

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 r TMS on cognitive dysfunction after TBI,but it is well tolerated.