阿尔茨海默病患者经颅磁刺激治疗的meta分析  

Repetitive transcranial megnetic stimulation for Alzheimer's patient:A meta-analysis

作　　者：梁宝今 王晓文[1] 张晗[1,3] 汪悦[1,4] 梁涛[2] 唐劲天[1] 

机构地区：[1]清华大学工程物理系粒子技术与辐射成像教育部重点实验室,北京100084 [2]河池市人民医院心血管内科,河池547000 [3]山东大学生命科学学院,济南250100 [4]佳木斯大学基础医学院,佳木斯154007

出　　处：《科技导报》2017年第9期95-99,共5页Science & Technology Review

摘　　要：目前经颅磁刺激(repetitive transcranial magnetic stimulation)对阿尔茨海默病(Alzheimer's disease)的疗效具有争议性。检索2015年12月以前Embase、medline、Cochrane Library、Ovid、Pubmed、Web of science、中国知网、万方医学网数据库,按照既定的纳入标准和排除标准查找rTMS治疗AD的临床随机对照试验。使用Rev Man5.3软件,应用标准误均数差(standardised mean difference),95%可信区间(confidence interval)分析。共纳入5个随机对照试验进行meta分析,共223例患者,其中rTMS组137例,对照组86例,MMSE结果显示rTMS组疗效线显著优于对照组,(SMD=1.05,95%CI:0.21、1.88,p=0.01,n=141),亚组分析显示高频组(>1 Hz)(p=0.02)疗效优于低频组(≤1 Hz)(p=0.27);ADAS-cog结果显示rTMS治疗显著优于对照组,(SMD=-0.71,95%CI:-1.04、-0.39,p<0.0001,n=168),高频组(>1 Hz)(p<0.001)比低频组(≤1 Hz)(p=0.05)疗效更佳。分析结果显示rTMS对AD认知功能有显著改善效果,且高频治疗效果优于低频治疗,然而仅纳入5个研究,后期需要增大随机对照试验样本量验证上述结论。Recent studies have proved that repetitive transcranial magnetic stimulations（rTMS） could improve cognitive function in people with Alzheimer＇s disease （AD）. However, it remains controversial in clinical effects. In this work, Embase, medline, Cochrane Library, Ovid, Pubmed, Web of science, and Chinese Database are searched for studies of rTMS treatment on AD patients with cognitive impairment published before 2015, and randomized studies with relevant primary outcomes of cognition are included. The outcome is expressed as the standardized mean difference （SMD） and 95% confidence interval （C/）. Five studies, comprising a total sample size of 223 AD patients （137 from stimulation groups, 86 from control groups）, are included in this meta-analysis. The effect of RTMS treatment on cognition is found in the outcome of MMSE （SMD=1.05,95% CI：0.21,1.88, p=0.01, n=141）. Subgroup analysis shows that high frequency stimulation （〉1 Hz） （p= 0.02） but not low frequency stimulation （≤1 Hz） （P=0.27） is significantly effective in improving cognition of AD patients. The outcome of ADAS-cog shows that rTMS treatment is significantly effective in improving cognition of AD patients （SMD=-0.71, 95% CI：-1.04,-0.39, p〈 0.0001, n=168）. High frequency stimulation （〉1 Hz） （p〈0.001） is significantly effective compared to the low frequency stimulation （≤1 Hz） （0=0.05）. Transcranial magnetic stimulation has significant therapeutic effect on cognitive function in Alzheimer＇s patients. High frequency stimulation is significantly effective compared to the low frequency stimulation. Due to the small number of studies included, more studies should be evaluated in AD patients in the future.

关 键 词：阿尔兹海默病 经颅磁刺激 META分析 随机对照试验 

分 类 号：R749.16[医药卫生—神经病学与精神病学]