中国全科医学 ›› 2020, Vol. 23 ›› Issue (31): 3976-3982.DOI: 10.12114/j.issn.1007-9572.2020.00.437

所属专题: 神经退行性病变最新文章合集 阿尔茨海默病最新文章合集

• 专题研究 • 上一篇    下一篇

重复经颅磁刺激对血管性认知障碍疗效的Meta分析

周文,张文超,黄开秀*   

  1. 400050重庆市,重庆医科大学附属康复医院
    *通信作者:黄开秀,副主任护师,硕士生导师;E-mail:1030226590@qq.com
  • 出版日期:2020-11-05 发布日期:2020-11-05

Meta-analysis of the Effect of Repetitive Transcranial Magnetic Stimulation on Vascular Cognitive Impairment 

ZHOU Wen,ZHANG Wenchao,HUANG Kaixiu*   

  1. The Affiliated Rehabilitation Hospital of CQMU,Chongqing 400050,China
    *Corresponding author:HUANG Kaixiu,Co-chief superintendent nurse,Master supervisor;E-mail:1030226590@qq.com
  • Published:2020-11-05 Online:2020-11-05

摘要: 背景 血管性认知障碍(VCI)不仅影响患者的生活质量,还给患者的全面功能康复带来较大困难。重复经颅磁刺激(rTMS)在神经系统和精神性疾病治疗方面的应用受到越来越多的关注,研究rTMS对VCI的疗效,对寻找非药物手段治疗VCI具有重要意义。目的 系统评价rTMS对我国VCI患者的疗效。方法 2019年10月—2020年1月,使用Cochrane协作网提供的系统评价方法,系统全面检索PubMed、Embase、EBSCO、Web of Science、Cochrane Library和中国知网数据库。同时筛查纳入文献的参考文献,结合手工检索相关期刊及灰色文献,检索时间截至2019-12-30,纳入关于rTMS治疗VCI的临床随机对照研究。由两名评价者采用Cochrane偏倚风险评估工具进行文献质量评价,采用RevMan 5.3软件进行Meta分析。结果 共纳入12篇临床随机对照文章,包括837例患者。Cochrane偏倚风险评估结果显示,12篇文献中,5篇报道了具体的随机分组方法,2篇进行了分配隐藏,2篇报道了避免测量偏倚的方法。Meta分析结果提示rTMS能够提高脑卒中患者的蒙特利尔认知评估量表(MoCA)、简易智力状态检查量表(MMSE)及Loewenstein认知功能评定表(LOTCA)评分。进行敏感性分析后,MoCA评分和MMSE评分结果采用固定效应模型,其总体效应值分别为:WMD=2.52,95%CI(2.04,3.00),P<0.05;WMD=1.55,95%CI(1.04,2.07),P<0.05。LOTCA评分因文献数量限制而采用定性分析,结果显示rTMS对其改善具有积极作用(P<0.05)。结论 rTMS对VCI患者的认知功能具有一定改善作用。但目前仍存在临床试验不够规范和研究样本量较小等问题,未来还需要更多高质量、大样本、多中心的随机对照研究来观察rTMS对VCI的疗效。

关键词: 血管性认知障碍, 重复经颅磁刺激, Meta分析

Abstract: Background Vascular cognitive impairment(VCI) affects the life quality,and causes great impact on the overall functional rehabilitation of patients. The application of repetitive transcranial magnetic stimulation(rTMS) in the treatment of neurological and mental diseases has attracted increasing attention.Studying the efficacy of rTMS is of great significance in finding non-drug approaches to VCI. Objective To systematically evaluate the therapeutic effect of rTMS in Chinese patients with VCI. Methods The systematic evaluation method was provided by the Cochrane Collaboration. From October 2019 to January 2020,clinical RCTs about VCI treated with rTMS published as of December 30,2019 were systemically and comprehensively searched from databases of PubMed,Embase,EBSCO,Web of Science,and Cochrane library and CNKI and printed journals. Meanwhile,those studies listed as references of the RCTs and relevant gray literature were also searched. The methodological quality of enrolled RCTs was evaluated by two reviewers independently using Cochrane risk-of-bias tool.RevMan 5.3 was used for meta-analysis. Results A total of 12 RCTs with 837 patients were included. The risk assessment demonstrated that 5 RCTs reported detailed random grouping strategies,2 used concealed allocation,and 2 used ways to avoid measurement bias. Meta-analysis indicated that rTMS improved MoCA,MMSE and LOTCA scores in stroke patients. Sensitivity analyses using fixed effect model revealed that the overall effect size for interventions on MoCA score and MMSE score was WMD=2.52〔95%CI(2.04,3.00),P<0.05〕,and WMD=1.55〔95%CI(1.04,2.07),P<0.05〕,respectively. Due to limited number of RCTs,qualitative analysis was performed on the effect of interventions on LOTCA score,and the results showed that rTMS had a positive effect on the improvement of LOTCA score. Conclusion These findings suggest that rTMS can improve the cognition function of VCI patients. Nonetheless,as the included RCTs are not very standardized with small sample,the effect of rTMS on VCI needs to be further evaluated by high-quality multicenter RCTs with a large sample size.

Key words: Vascular cognitive impairment, Repeated transcranial magnetic stimulation, Meta-analysis