经颅直流电刺激不同靶点治疗帕金森病效果的网状Meta分析

Transcranial direct current stimulation at different targets for Parkinson’s disease:a network Meta-analysis

目的:系统评价经颅直流电刺激对帕金森患者运动功能的康复疗效,并比较经颅直流电刺激作用于不同靶点对帕金森患者运动功能的疗效差异,为临床中经颅直流电刺激的靶点选择提供理论依据。方法:计算机检索Cochrane Library、PubMed、Web of Science、中国知网、维普和万方数据库,以“帕金森、经颅直流电刺激”为中文检索词,以“Parkinson,transcranial direct current stimulation”为英文检索词,收集从各数据库建库至2023年1月发表的关于经颅直流电刺激改善帕金森患者运动功能的随机对照试验。使用Cochrane 5.1.0偏倚风险评估工具和PEDro量表对纳入研究进行质量评价。采用RevMan 5.4和Stata 17.0软件对结局指标进行Meta分析。结果:①最终纳入15项随机对照试验,PEDro量表评估显示均为高质量或极高质量研究。②Meta分析显示,与对照组相比经颅直流电刺激可显著提高UPDRS-Ⅲ评分(MD=-2.49,95%CI:-4.42至-0.55,P<0.05)、步频评分(MD=0.07,95%CI:0.03-0.11,P<0.05)和步速评分(MD=0.02,95%CI:0.00-0.05,P<0.05),但对BBS评分(MD=2.57,95%CI:-0.74-5.87,P>0.05)的提高不明显。③网状Meta分析概率排序结果显示,在UPDRS-Ⅲ评分方面,刺激靶点疗效的概率排序结果为背外侧前额叶皮质(52.4%)>初级皮质运动区(45.8%)>大脑中央点(1.8%)>常规康复治疗(0%);在步频评分方面,刺激靶点疗效的概率排序结果为小脑(50.1%)>大脑中央点(45.8%)>背外侧前额叶皮质(3.9%)>初级皮质运动区(0.2%)>常规康复治疗(0%);在步速评分方面,刺激靶点疗效的概率排序结果为小脑(64.8%)>背外侧前额叶皮质(23.8%)>大脑中央点(9.4%)>初级皮质运动区(1.7%)>常规康复治疗(0.4%);在BBS评分方面,刺激靶点疗效的概率排序结果为:小脑(77.4%)>背外侧前额叶皮质(20.7%)>大脑中央点(0.7%)>常规康复治疗(0.2%)。结论:经颅直流电刺激可显著改善帕金森患者运动功能,其中刺激背外侧前额叶皮质区域对改善帕金森患者运动协调方面疗效更佳,而刺激小脑区域对改善帕金森患者步行和平衡方面疗效更佳。

OBJECTIVE:To systematically evaluate the efficacy of transcranial direct current stimulation on the motor function of patients with Parkinson’s disease,and to compare the efficacy of transcranial direct current stimulation at different targets on the motor function of patients with Parkinson’s disease,so as to provide a theoretical basis for the target selection of transcranial direct current stimulation in clinical practice.METHODS:Cochrane Library,PubMed,Web of Science,CNKI,VIP,WanFang Data were retrieved for randomized controlled trials on the improvement of motor function in patients with Parkinson’s disease by transcranial direct current stimulation published from the database inception to January 2023.The keywords were“Parkinson,transcranial direct current stimulation”in English and Chinese.The quality of the included studies was evaluated using the Cochrane 5.1.0 risk of bias assessment tool and the PEDro scale.Meta-analysis of outcome indicators was performed using RevMan 5.4 and Stata 17.0 software.RESULTS:Fifteen randomized controlled trials were finally included,and the PEDro scale showed that all were high-quality or very high-quality studies.Meta-analysis showed that transcranial direct current stimulation significantly improved Unified-Parkinson Disease Rating Scale part III score[mean difference(MD)=-2.49,95%confidence interval(CI):-4.42 to-0.55,P<0.05),step frequency score(MD=0.07,95%CI:0.03-0.11,P<0.05)and step speed score(MD=0.02,95%CI:0.00-0.05,P<0.05),but not for Berg Balance Scale scores(MD=2.57,95%CI:-0.74 to 5.87,P>0.05).Network Meta-analysis probability ranking:In terms of Unified-Parkinson Disease Rating Scale part III scores,the probability ranking results of target stimulation efficacy were dorsal lateral prefrontal cortex(52.4%)>primary motor cortex(45.8%)>central point of the brain(1.8%)>conventional rehabilitation(0%);in terms of gait frequency scores,the probability probability ranking results of target stimulation efficacy were cerebellum(50.1%)>central point of the brain(45.8%)>dorsal lateral prefrontal cortex(3.9%)>primary motor cortex(0.2%)>conventional rehabilitation(0%);in terms of gait speed scores,the probability ranking results of target stimulation efficacy were cerebellum(64.8%)>dorsal lateral prefrontal cortex(23.8%)>central point of the brain(9.4%)>primary motor cortex(1.7%)>conventional rehabilitation(0.4%);in terms of Berg Balance Scale scores,the probability ranking results of target stimulation efficacy were cerebellum(77.4%)>dorsal lateral prefrontal cortex(20.7%)>central point of the brain(0.7%)>conventional rehabilitation(0.2%).CONCLUSION:Transcranial direct current stimulation significantly improves motor function of patients with Parkinson’s disease,with better motor coordination in the dorsolateral prefrontal cortex and better walking and balance in the cerebellum.