经颅直流电刺激治疗脑卒中后失语症临床疗效Meta分析

Effect of Transcranial Direct Current Stimulation in the Treatment of Aphasia after Stroke:A Meta-Analysis

目的:采用Meta分析方法评价经颅直流电刺激(tDCS)治疗脑卒中后失语症的临床疗效。方法:通过计算机检索中国知网数据库、万方数据库、中国生物医学文献数据库、维普中文期刊全文数据库等中文数据库和PubMed、Web of Science、Embase、Cochrane Library等英文数据库有关tDCS治疗脑卒中后失语症的随机对照试验(RCTs),检索时间为建库至2021年8月。主要结局指标包括临床疗效、失语症状评分[西方失语症成套测验(WAB)、图片命名能力、日常生活交流能力表(CADL)等]。由2名研究员根据纳入和排除标准进行文献筛选、资料提取、质量评价。等级资料以比值比(OR)和95%可信区间(CI)作为效应指标,采用Stata 15对临床疗效进行Meta分析;采用RevMan 5.4软件进行连续型数据Meta分析,连续型资料以均数差(MD)及95%CI为效应指标。通过P值和I^(2)值综合判断是否存在异质性,若纳入研究具有同质性(P≥0.1,I^(2)≤50%),采用固定效应模型;若纳入研究异质性较大(P<0.1,I^(2)>50%)时,采用随机效应模型。结果:纳入16项RCTs,共843例患者。Meta分析结果显示,(1)临床疗效:与对照组比较,试验组临床疗效明显更高[OR=3.46,95%CI(2.30,5.21),P<0.001]。(2)WAB评分:与对照组比较,试验组WAB-失语商(WAB-AQ)评分明显更高[MD=14.06,95%CI(11.82,16.29),Z=12.32,P<0.00001],WAB-自发语言评分明显更高[MD=2.13,95%CI(1.32,2.94),Z=5.17,P<0.00001],WAB-听理解评分明显更高[MD=0.50,95%CI(0.05,0.95),Z=2.20,P=0.03],WAB-复述评分明显更高[MD=2.58,95%CI(2.18,2.98),Z=12.54,P<0.00001],WAB-命名评分明显更高[MD=2.07,95%CI(1.63,2.50),Z=9.28,P<0.00001]。(3)图片命名能力:与对照组比较,试验组图片命名评分明显更高[MD=23.17,95%CI(10.11,36.23),Z=3.48,P=0.0005]。(4)CADL评分:与对照组比较,试验组CADL评分明显更高[MD=15.08,95%CI(10.88,19.27),Z=7.05,P<0.00001]。结结论论:tDCS可有效改善脑卒中后失语症患者日常生活交流能力、图片命名能力及自发语言、听理解、复述、命名等语言方面能力,临床疗效较高,且安全性良好。由于纳入研究的局限性,下一步研究仍需要开展高质量、大样本的临床随机对照研究,以提供更可靠的循证依据。

Objective:To evaluate the clinical efficacy of transcranial direct current stimulation(tDCS) in the treatment of aphasia after stroke by meta-analysis.Methods:Data were searched from the Chinese databases(China National Knowledge Infrastructure Database,Wanfang Database,China Biology Medicine Database,VIP Database) and English databases(PubMed,Web of Science,Embase and Cochrane Library).The randomized controlled trials(RCTs) of tDCS in the treatment of aphasia after stroke were included,and the retrieval time for each database was from inception to August 2021.The main outcome measures were clinical efficacy,aphasia symptom scores [Western aphasia battery(WAB),picture naming test,communication abilities of daily living(CADL),etc.].Two researchers conducted literature screening,data extraction and quality evaluation independently according to the inclusion and exclusion criteria.The odds ratio(OR) and 95% confidence interval(CI) were used as the effect indicators for the ranking data and Stata 15 was used for meta-analysis of clinical efficacy;RevMan 5.4 was used to analyze the continuous data by Meta-analysis,and the mean difference(MD) and 95% CI were used as the effect indexes.The statistical heterogeneity was assessed by probability value(P value) and heterogeneity value(I^(2) value).The fixed effects model was used when the included studies were homogeneous(I^(2)≤50%,P≥0.1),while the random-effects model was used for analysis when the included studies were heterogeneous(I^(2)>50%,P<0.1).Results:A total of 16 RCTs with 843 cases were included.The results of meta-analysis showed that,(1) Clinical efficacy:compared with the control group,the clinical effect of the experimental group was higher [OR=3.46,95% CI(2.30,5.21),P<0.001].(2) WAB score:compared with the control group,the WAB-aphasia quotient(WAB-AQ) score of the experimental group was significantly higher [MD=14.06,95% CI(11.82,16.29),Z=12.32,P<0.000 01],WAB-spontaneous language score was significantly higher [MD=2.13,95% CI(1.32,2.94),Z=5.17,P<0.000 01],WAB-listening comprehension score was significantly higher [MD=0.50,95% CI(0.05,0.95)],Z=2.20,P=0.03],WAB-retelling score was significantly higher [MD=2.58,95% CI(2.18,2.98),Z=12.54,P<0.000 01] and WAB-naming score was significantly higher [MD=2.07,95% CI(1.63,2.50),Z=9.28,P<0.000 01].(3) Picture naming test:compared with the control group,the score of picture naming test in the experimental group was higher [MD=23.17,95% CI(10.11,36.23),Z=3.48,P=0.000 5].(4) CADL score:compared with the control group,the CADL score of the experimental group was higher [MD=15.08,95% CI(10.88,19.27),Z=7.05,P<0.000 01].Conclusion:tDCS can effectively improve the communication ability of daily life,picture naming ability and language abilities of spontaneous language,listening comprehension,retelling and naming in patients with aphasia after stroke,with clinical efficacy and good safety.Due to the limitations of the included studies,high-quality,large-sample clinical randomized controlled trials are still needed in the further research to provide more reliable evidence-based basis.