非侵入式脑刺激对帕金森病患者执行功能的影响:网状meta分析  

Effects of non-invasive brain stimulation on executive functions in Parkinson’s disease patients:a network meta-analysis

作　　者：黄木兰 王丽萍[1,2] 胡柯嘉 贺华 HUANG Mulan;WANG Liping;HU Kejia;HE Hua(School of Health Science and Engineering,University of Shanghai for Science and Technology,Shanghai 200093,China;Department of Neurosurgery,The Third Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200438,China;Department of Functional Neurosurgery,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海理工大学健康科学与工程学院,上海200093 [2]海军军医大学(第二军医大学)第三附属医院神经外科,上海200438 [3]上海交通大学医学院附属瑞金医院功能神经外科,上海200025

出　　处：《海军军医大学学报》2024年第5期584-591,共8页Academic Journal of Naval Medical University

摘　　要：目的探索非侵入式脑刺激措施改善帕金森病患者执行功能的有效性。方法检索Web of Science、PubMed、EMBASE、中国知网、万方数据5个数据库中关于经颅磁刺激、经颅交流电刺激、经颅直流电刺激3种非侵入式脑刺激干预措施治疗帕金森病且结局指标包括执行功能的随机对照试验,根据预先确定的标准筛选文献并提取数据。采用网状meta分析方法比较3种非侵入式脑刺激干预措施对帕金森病患者执行功能障碍的疗效,使用标准化均数差(SMD)及95%贝叶斯可信区间(CrI)汇总结果,通过累积排序曲线下面积(SUCRA)对各干预措施的疗效进行排序。结果共纳入20项随机对照试验,包括809例帕金森病患者。与对照组相比,经颅磁刺激对帕金森病患者的执行功能有显著改善效果(SMD=0.16,95%CrI 0.01~0.32)。各干预措施疗效的概率排序结果显示,对帕金森病患者执行功能障碍疗效最佳的干预措施排序为经颅磁刺激>经颅交流电刺激>经颅直流电刺激>对照(SUCRA分别为0.72、0.61、0.41、0.25),经颅磁刺激最有可能是疗效最佳的干预措施。结论目前的有限证据显示,经颅磁刺激对帕金森病患者的执行功能有直接的改善效果。受纳入研究的数量及质量影响,上述结论需进行更进一步的高质量研究验证。Objective To investigate the effectiveness of non-invasive brain stimulation in improving the executive functions of patients with Parkinson’s disease(PD).Methods The randomized controlled trials(RCTs)about transcranial magnetic stimulation(TMS),transcranial alternating current stimulation(tACS)or transcranial direct current stimulation(tDCS)in treating PD patients with outcome indicators including executive functions were retrieved from 5 databases(Web of Science,PubMed,EMBASE,CNKI,and Wanfang data).The literatures were screened according to the predetermined criteria and the data were extracted.The effectiveness of 3 non-invasive brain stimulation interventions on executive dysfunction of PD patients was compared using network meta-analysis(NMA).The results were summarized by standardized mean difference(SMD)and 95%Bayesian credibility interval(CrI),and the effectiveness of each intervention was ranked by surface under the cumulative ranking curve(SUCRA).Results A total of 20 RCTs(809 PD patients)were included.Compared with the control group,TMS significantly improved the executive functions of PD patients(SMD=0.16,95%CrI 0.01-0.32).The probability ranking results of the effectiveness of the interventions on the executive functions of PD patients were TMS>tACS>tDCS>control(SUCRA=0.72,0.61,0.41,0.25,respectively).TMS was the most likely intervention with the best performance.Conclusion TMS has a direct improvement effect on executive functions of PD patients.Limited by the number and quality of the included studies,the above conclusion need to be further verified by high-quality studies.

关 键 词：帕金森病 执行功能 非侵入式脑刺激 经颅磁刺激 网状meta分析 

分 类 号：R742.5[医药卫生—神经病学与精神病学]