高频重复经颅磁刺激对脑卒中患者上肢运动功能及日常活动能力的影响:网状Meta分析

Effect of high-frequency repetitive transcranial magnetic stimulation on upper limb motor function and activities of daily living in patients after stroke:A network Meta-analysis

目的:系统评价不同频率的高频重复经颅磁刺激(rTMS)对脑卒中患者上肢运动功能和日常活动能力的影响。方法:系统检索知网、万方、维普、中国生物医学数据库(CBM)、PubMed、Cochrane Library、Embase、Web of Science数据库中关于rTMS治疗脑卒中患者的随机对照试验(RCT),检索时间为建库至2021年2月。由两位评审员对纳入文献进行独立筛选、提取相关数据,并运用Cochrane手册和物理治疗证据数据库量表(PEDro)对文献进行风险质量评估,运用Stata16.0对数据进行Meta分析。结果:最终获得29项研究,共2095例受试者。网状Meta分析结果显示,在上肢Fugl-Meyer量表(FMA-UE)和改良Barthel指数(MBI)中,与常规治疗组相比,≥10Hz rTMS均能明显提高FMA-UE和MBI评分,差异具有统计学意义(P<0.05);5Hz rTMS在提高MBI评分方面,效果优于常规治疗组,差异具有统计学意义(P<0.05)。累计概率排序结果显示,≥10Hz rTMS在提高FMA-UE、MBI评分方面,概率排名为最高。对于轻、重度功能障碍的患者,亚组分析结果显示≥10Hz rTMS在改善FMA-UE、MBI评分方面均更优。结论:基于当前证据显示,临床上采用rTMS改善脑卒中上肢运动功能障碍和日常活动能力时可首选≥10Hz rTMS。上述结论尚待更多高质量研究予以验证。

Objective:To systematically evaluate the effect of high-frequency repetitive transcranial magnetic stimulation(rTMS)on the upper limb motor function and daily activity ability in stroke patients through the network Meta analysis.Methods:The random controlled trials(RCTs)about the treatment of stroke patients with rTMS were searched from CNKI,Wanfang,VIP,ChinaBiomedicalDatabase(CBM),PubMed,Cochrane Library,Embase and Web of Science databases,and the retrieval time range was from the establishment of the database to December 2020.Two reviewers used physiotherapy evidence database(PEDro)to assess the risk quality of literature and Meta analysis using Stata16.0.k to evaluate the risk quality of the included literature.The statistical analysis was conducted by stata16.0 after data extraction.Results:The enrolled 29 studies contained 2095 subjects.The mesh Meta-analysis showed that the Fugl-Meyer Assessment Upper Extremity Scale(FMA-UE)scores and the modified Barthel index(MBI)scores were significantly increased by 5 Hz rTMS(P<0.05).The cumulative probability ranking results showed that the 10 Hz rTMS had the highest probability ranking in improving the FMA-UE and MBI scores.For patients with mild and severe dysfunction,the results of reticular Meta subgroup analysis showed that the FMA-UE and MBI scores were statistically significant(P<0.05).In addition,10 Hz rTMS was better than 3 Hz rTMS in improving the FMA-UE score in mild patients.In improving the MBI score of severe patients,10 Hz rTMS was better than 5 Hz rTMS,and the difference was statistically significant(P<0.05).There was no significant difference in the pairwise comparisons between the remaining groups.Conclusion:According to the current evidence,10Hz rTMS is preferred for clinically using rTMS to improve upper limb motor dysfunction and daily activities in stroke patients.These conclusions need to be verified by more high-quality studies.