低频重复经颅磁刺激治疗卒中后失语的系统评价及Meta分析

A systematic review and Meta-analysis of low-frequency repetitive transcranial magnetic stimulation in the treatment of aphasia after stroke

目的通过Meta分析探讨低频重复经颅磁刺激治疗卒中后失语的临床疗效。方法从数据库建立到2023年10月,检索中国知网、中国生物医学文献数据库、万方数据库、维普数据库、PubMed、Cochrane Library、Embase、Web of Science 8个文献数据库中关于经颅磁刺激治疗卒中后失语的文章。筛选文献后,使用Revman 5.4软件进行Meta分析。结果纳入7项随机对照试验,共258例患者。结果显示,接受低频重复经颅磁刺激后,干预组的CCAT评分优于对照组(MD=1.50,95%CI:1.046~1.960,P<0.001),其中,对话(MD=1.62,95%CI:0.60~2.63,P=0.002),描述(MD=1.86,95%CI:1.30~2.42,P<0.001),表达(MD=2.54,95%CI:1.96~3.12,P<0.001),重复(MD=0.99,95%CI:0.45~1.52,P<0.001),自发书写(MD=1.28,95%CI:0.81~1.75,P<0.001),匹配(MD=-0.41,95%CI:-0.74~-0.08,P=0.01)。西方失语症测验(western aphasia battery,WAB)量表得分差异无统计学意义(MD=-2.44,95%CI:-25.33~20.45,P=0.83)。结论低频重复经颅磁刺激可有效改善卒中后失语患者的对话、描述、表达、重复、自发书写等方面的语言功能。

Objective:To investigate the clinical efficacy of low-frequency repetitive transcranial magnetic stimulation in the treatment of aphasia after stroke through Meta-analysis.Methods:From the establishment of the database to October 2023,articles on transcranial magnetic stimulation in the treatment of aphasia after stroke were searched from eight literature databases:CNKI,China Biomedical Literature Database,Wanfang Database,VIP database,PubMed,Cochrane Library,Embase and Web of Science.After literature screening,Meta-analysis was performed using Revman5.4 software.Results:A total of seven randomized controlled trials were included,involving 258 patients.Results:Meta-analysis showed that the CCAT score of the intervention group was better than that of the control group after receiving low-frequency repetitive transcranial magnetic stimulation(MD=1.50,95%CI:1.046,1.960,P<0.001),among which,session(MD=1.62,95%CI:0.60,2.63,P=0.002).Description(MD=1.86,95%CI:1.30,2.42,P<0.001),(MD=2.54,95%CI:1.96,3.12,P<0.001),repeat(MD=0.99,95%CI:0.45,1.52,P<0.001),spontaneous writing(MD=1.28,95%CI:0.81,1.75,P<0.001),match(MD=-0.41,95%CI:-0.74,-0.08,P=0.01).WAB-AQ score no statistical significance(MD=-2.44,95%CI:-25.33,20.45,P=0.83).Conclusion:Low-frequency repetitive transcranial magnetic stimulation can effectively improve the speech function of patients with aphasia after stroke in terms of conversation,description,expression,repetition and spontaneous writing.