非侵入性脑刺激对孤独症谱系障碍治疗效果的系统评价及网状Meta分析

Effect of Non-invasive Brain Stimulation on Autism Spectrum Disorder:a Systematic Review and Network Metaanalysis

背景既往研究表明,非侵入性脑刺激(NIBS)改善孤独症谱系障碍(ASD)的疗效不一,且缺乏不同NIBS的疗效比较。目的系统评价NIBS对ASD的康复疗效,并比较两种NIBS的疗效差异。方法计算机检索PubMed、Embase、Cochrane Library、Scopus、Web of Science、中国知网、万方数据知识服务平台、维普网和中国生物医学文献数据库,搜集NIBS改善ASD的随机对照试验(RCT),试验组在对照组的基础上增加NIBS〔包括经颅直流电刺激(tDCS)和重复经颅磁刺激(rTMS)〕。检索时间为建库至2021年12月。由2名研究员独立筛选文献和提取数据资料,并采用Cochrane系统评价手册5.1.0对纳入研究进行偏倚风险评估。采用RevMan 5.3和R 4.0.2软件进行统计分析。结果最终纳入22篇文献,661例患者。Meta分析结果表明,NIBS可降低ASD患者孤独症行为检查量表(ABC)评分〔MD=-8.80,95%CI(-10.98,-6.62),P<0.05〕、儿童孤独症评定量表(CARS)评分〔MD=-2.93,95%CI(-3.63,-2.24),P<0.05〕、自闭症治疗评估表(ATEC)评分〔MD=-9.13,95%CI(-12.79,-5.47),P<0.05〕、焦虑自评量表(SAS)评分〔MD=-7.20,95%CI(-10.55,-3.85),P<0.05〕、抑郁自评量表(SDS)评分〔MD=-8.89,95%CI(-13.21,-4.57),P<0.05〕和失匹配负波潜伏期〔MD=-5.97,95%CI(-9.42,-2.53),P<0.05〕,提高ASD患者发育商(DQ)评分〔MD=5.22,95%CI(3.41,7.04),P<0.05〕和失匹配负波幅值〔MD=1.54,95%CI(0.57,2.51),P<0.05〕。网状Meta分析结果表明,两种NIBS对ASD患者ABC评分影响的最佳概率排序:tDCS(P=0.931)>rTMS(P=0.069)。发表偏倚显示倒漏斗图无明显不对称,但不排除存在发表偏倚的可能性。结论本研究结果表明,NIBS能在一定程度上改善ASD,且tDCS优于rTMS。

Background Previous studies have shown various improvement effects of non-invasive brain stimulation(NIBS)on autism spectrum disorder(ASD),and there is a lack of comparison of the efficacy of different types of NIBS.Objective To systematically evaluate the effect of NIBS on ASD,and to compare the curative effects of two types of NIBS.Methods Randomized controlled trials(RCTs)about the effect of NIBS on ASD〔both experimental and control groups received conventional treatments,and the experimental group additionally received transcranial direct current stimulation(tDCS)or repetitive transcranial magnetic stimulation(rTMS)〕were retrieved from databases of PubMed,Embase,Cochrane Library,Scopus,Web of Science,CNKI,Wanfang Data,CQVIP,and SinoMed from inception to December 2021.Two researchers independently implemented literature screening and data extraction,and used the Cochrane Handbook for Systematic Reviews of Interventions(version 5.1.0)to assess the risk of bias of the included studies.The statistical analysis was performed using RevMan 5.3 and R 4.0.2.Results Ultimately,22 studies involving 661 patients were included.Meta-analysis showed that NIBS could reduce Autism Behavior Checklist(ABC)score〔MD=-8.80,95%CI(-10.98,-6.62),P<0.05〕,Childhood Autism Rating Scale score〔MD=-2.93,95%CI(-3.63,-2.24),P<0.05〕,Autism Treatment Evaluation Checklist score〔MD=-9.13,95%CI(-12.79,-5.47),P<0.05〕,Self-rating Anxiety Scale score〔MD=-7.20,95%CI(-10.55,-3.85),P<0.05〕,Self-rating Depression Scale score〔MD=-8.89,95%CI(-13.21,-4.57),P<0.05〕and mismatch negativity latency period〔MD=-5.97,95%CI(-9.42,-2.53),P<0.05〕,and increase development quotient score〔MD=5.22,95%CI(3.41,7.04),P<0.05〕and mismatch negativity amplitude〔MD=1.54,95%CI(0.57,2.51),P<0.05〕.No obvious asymmetry was detected in the inverted funnel plot measuring publication bias,but could not exclude the potential for publication bias.Network meta-analysis showed that the best probabilistic ranking of the effects of two different NIBS on the ABC score is tDCS(P=0.931)>rTMS(P=0.069).Conclusion Existing evidence shows that NIBS can improve ASD,and the effect of tDCS is better than that of rTMS.