不同频率重复经颅磁刺激对脑卒中后认知障碍疗效的Meta分析

Therapeutic effect of different-frequency repetitive transcranial magnetic stimulations on post-stroke cognitive impairment:a Meta-analysis

目的:脑卒中后认知障碍主要表现为注意力、定向力、记忆力及视空间功能等障碍,重复经颅磁刺激可刺激大脑神经细胞,改变神经细胞的动作电位,提高大脑言语、记忆力、注意力及执行能力等认知功能。文章系统评价重复经颅磁刺激改善脑卒中后认知障碍的疗效。方法:应用计算机检索中国知网、维普、PubMed、Cochrane Library、EBSCO、Web of Science等电子数据库关于重复经颅磁刺激治疗脑卒中患者认知障碍的随机对照试验。检索时限为各数据库建立到2021年12月,以蒙特利尔认知评估量表、简易精神状态量表、事件相关电位P300变化情况(潜伏期、波幅)及改良Barthel指数为结局指标,按照《Cochrane干预措施系统评价手册》中的“偏倚风险评估”工具对筛选过后的文献进行风险评估,使用RevMan 5.4软件进行Meta分析。结果:(1)共纳入16个随机对照试验,包括847例患者。(2)Meta分析结果显示:与对照组相比,重复经颅磁刺激治疗后患者的蒙特利尔认知评估量表评分(MD=3.40,95%CI:2.57-4.24,P<0.0001)、简易精神状态量表评分(MD=2.22,95%CI:0.78-3.65,P=0.002)、听觉事件相关电位P300潜伏期(MD=-27.11,95%CI:-35.56至-18.66,P<0.0001)和P300波幅(MD=1.91,95%CI:1.06-2.76,P<0.0001)、改良Barthel指数评分(MD=6.98,95%CI:3.41-10.56,P=0.0001)改善效果均优于对照组。(3)亚组分析结果显示:低频(≤1 Hz)重复经颅磁刺激改善脑卒中患者认知功能的效果略低于高频(>1 Hz)重复经颅磁刺激,但总体二者结果差异不大。结论:当前临床证据显示,高频与低频重复经颅磁刺激治疗可以有效改善脑卒中患者认知功能和日常生活能力,受纳入研究数量和质量的限制,上述结论尚需更多高质量研究予以验证。

OBJECTIVE:Post-stroke cognitive impairment(PSCI)is mainly manifested as impairment of attention,orientation,memory and visuospatial functions.Repetitive transcranial magnetic stimulation can stimulate brain nerve cells,change the action potential of nerve cells,and improve brain cognitive functions such as speech,memory,attention,and executive ability.This study systematically evaluated the efficacy of repetitive transcranial magnetic stimulation in improving cognitive impairment in stroke patients.METHODS:Randomized controlled trials addressing repetitive transcranial magnetic stimulation for cognitive impairment in stroke patients were searched from CNKI,VIP database,PubMed,Cochrane Library,EBSCO,Web of Science and other electronic databases.The retrieval time was from the database inception to December 2021.Montreal Cognitive Assessment Scale,Mini-Mental State Examination,P300 event-related potential(latency,amplitude),and modified Barthel index were used as outcome indicators.The risk assessment of the screened literatures was carried out according to the Cochrane tool described in the Cochrane Handbook for Systematic Reviews of Interventions.RevMan5.4 software was used for Meta-analysis.RESULTS:A total of 16 randomized controlled trials with 847 patients were included.Meta-analysis results showed that Montreal Cognitive Assessment Scale[mean difference(MD)=3.40,95%confidence interval(CI):2.57-4.24,P<0.0001),Mini-Mental State Examination(MD=2.22,95%CI:0.78-3.65,P=0.002),auditory event-related potential P300 latency(MD=-27.11,95%CI:-35.56 to-18.66,P<0.0001)and P300 amplitude(MD=1.91,95%CI:1.06-2.76,P<0.0001),and modified Barthel index score(MD=6.98,95%CI:3.41-10.56,P=0.0001)were better in the experimental group than the control group.Subgroup analysis showed that low-frequency(≤1 Hz)repetitive transcranial magnetic stimulation had a slightly lower effect than high-frequency(>1 Hz)repetitive transcranial magnetic stimulation in improving cognitive function of stroke patients,but there was no significant difference between them.CONCLUSION:Current evidence suggests that both high-and low-frequency repetitive transcranial magnetic stimulation therapies can effectively improve the cognitive function and daily living ability of stroke patients.Limited by the number and quality of included studies,the above conclusions need to be verified by more high-quality studies.