经颅磁刺激不同靶点干预孤独症谱系障碍儿童语言及行为的Meta分析

Meta⁃Analysis of Different Targets of Transcranial Magnetic Stimulation in the Intervention of Language and Behavior in Children with Autism Spectrum Disorders

目的通过分析既往文献对经颅磁刺激(TMS)颅内刺激靶点的选择与孤独症谱系障碍(ASD)患儿语言行为干预措施临床效果的相关性,探讨靶点选择的最优方案。方法检索2016年6月至2021年9月数据库(Embase、Medline、Cochrane Library、Ovid、PubMed、Web of science、中国知网、万方医学网数据库),按照纳入标准(<14岁ASD患儿、TMS干预、符合随机要求)和排除标准(未开展自闭症儿童行为量表评估、未进行TMS固定脑区刺激)对上述数据库[1]进行检索。数据的分析采用RevMan5.3软件,应用标准误均数差、95%可信区间进行统计学分析。结果共纳入5个随机对照实验共401例患儿进行Meta分析,背外侧前额叶皮层刺激作为实验组,共计200例,Broca区刺激作为对照组,共计201例,ABC结果显示Broca区刺激效果显著优于对照组[SMD=-1.14;95%CI:(-2.69,-0.59);P<0.01,n=401]。分析结果显示选择Broca区刺激对ASD患儿认知功能有显著改善效果。结论ASD患儿经颅磁刺激可以显著改善语言迟缓、刻板行为等临床症状,其中对Broca区刺激能取得更好的临床效果。

Objective This study aims to explore the optimal selection of intracranial stimulation targets for Transcranial Magnetic Stimulation(TMS)in children with Autism Spectrum Disorder(ASD)by analyzing the correlation between target selection and the clinical efficacy of language behavior interventions in existing literature.Methods A comprehensive search was conducted across databases including Embase,Medline,Cochrane Library,Ovid,PubMed,Web of Science,CNKI,and Wanfang Data from June 2016 to September 2021.Inclusion criteria were ASD children under 14 years of age,TMS intervention,and alignment with randomization requirements,while exclusion criteria included absence of ABC or scale evaluation and lack of fixed brain region stimulation with TMS.Data analysis was performed using RevMan 5.3 software,employing standardized mean differences(SMD)and 95%confidence intervals(CIs)for statistical analysis.Results A total of 5 randomized controlled trials involving 401 patients were included in the meta⁃analysis.The experimental group,comprising 200 cases,received stimulation of the dorsolateral prefrontal cortex,while the control group,comprising 201 cases,received Broca’s area stimulation.The ABC results indicated that stimulation of Broca’s area had a significantly better effect(SMD=-1.14,95%CI:[-2.69,-0.59],P<0.01,n=401).Analysis revealed that Broca's area stimulation significantly improved cognitive functions in ASD children.Conclusion TMS can significantly ameliorate clinical symptoms such as language disorder and stereotyped behaviors in children with ASD,with Broca’s area stimulation providing su⁃perior clinical outcomes.