经颅直流电刺激改善脑卒中患者下肢运动功能障碍的Meta分析  

Meta-analysis of transcranial direct current stimulation in improving lower limb motor dysfunction in stroke patients

作　　者：王贺 于少泓[2,3] Wang He;Yu Shaohong(College of Rehabilitation Medicine,Shandong University of Traditional Chinese Medicine,Jinan 250355,Shandong Province,China;College of Medicine,Shandong University of Traditional Chinese Medicine,Jinan 250355,Shandong Province,China;Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250001,Shandong Province,China)

机构地区：[1]山东中医药大学康复医学院,山东省济南市250355 [2]山东中医药大学医学院,山东省济南市250355 [3]山东中医药大学第二附属医院,山东省济南市250001

出　　处：《中国组织工程研究》2025年第30期6556-6565,共10页Chinese Journal of Tissue Engineering Research

基　　金：山东省自然科学基金面上项目(ZR2024MH048),项目负责人:于少泓;教育部产学合作协同育人项目(202102424004),项目负责人:于少泓。

摘　　要：目的:评估经颅直流电刺激对脑卒中患者下肢运动功能障碍的康复疗效。方法:计算机检索PubMed、Web of Science、Embase、Cochrane Library、Scopus、中国知网、维普数据库和万方数据库,搜集已公开发表的有关经颅直流电刺激治疗脑卒中患者下肢运动功能障碍的随机对照试验,检索时限均从各数据库建库至2024-09-22。采用RevMan 5.4软件进行传统Meta分析,采用Stata 14.0软件进行网状Meta分析,采用GRADE进行证据等级评价。结果:共纳入17项研究,涉及851例患者。传统Meta分析显示,经颅直流电刺激能够提高脑卒中患者的Fugl-Meyer下肢运动功能量表评分[MD=1.97,95%CI(0.78,3.16),P<0.01]、Berg平衡功能量表评分[MD=3.92,95%CI(1.67,6.17),P<0.01]和Tinetti平衡与步态量表评分[MD=2.62,95%CI(0.44,4.80),P<0.05],降低计时起立行走测试时间[MD=-1.82,95%CI(-2.51,-1.12),P<0.01]和5次坐立测试时间[MD=-0.78,95%CI(-1.31,-0.26),P<0.01]。网状Meta分析显示,经颅直流电刺激对于50-60岁,病程≤6个月的脑卒中患者下肢运动功能治疗效果更好;电流强度为2 mA、每天治疗时间>30 min、干预周期>3周的治疗方案对于脑卒中患者的下肢运动能力改善效果更佳。结论:当前证据表明,经颅直流电刺激对脑卒中患者下肢运动功能、步行能力以及平衡能力均有较好的治疗效果,其中下肢运动功能的改善效果受患者年龄和病程的影响,且与电流强度、每天治疗时间和治疗周期存在一定程度的剂量反应关系。OBJECTIVE:To systematically evaluate the effects of transcranial direct current stimulation on lower limb motor function in patients with stroke.METHODS:The randomized controlled trials about the effects of transcranial direct current stimulation on patients with stroke were retrieved from databases(PubMed,Web of Science,Embase,Cochrane Library,Scopus,CNKI,VIP,and WanFang Data)from the establishment of the databases to September 22,2024.RevMan 5.4 software and Stata 14.0 software were used for traditional meta-analysis and network meta-analysis,respectively.GRADE was used to evaluate the level of evidence.RESULTS:A total of 17 studies involving 851 patients were included.Traditional meta-analysis showed that transcranial direct current stimulation improved the Fugl-Meyer Lower Extremity Motor Function Scale scores[MD=1.97,95%CI(0.78,3.16),P<0.01],Berg Balance Scale scores[MD=3.92,95%CI(1.67,6.17),P<0.01],and Tinetti Balance and Gait Scale score[MD=2.62,95%CI(0.44,4.80),P<0.05],and reduced the Timed Up-and-Go Test time[MD=-1.82,95%CI(-2.51,-1.12),P<0.01]and Five Times Sit-To-Stand test time[MD=-0.78,95%CI(-1.31,-0.26),P<0.01].Network meta-analysis showed that transcranial direct current stimulation was more effective in the treatment of lower limb motor function in stroke patients aged 50-60 years with a disease duration of≤6 months,and that a treatment regimen with a current intensity of 2 mA,a treatment duration of>30 minutes per day,and a period of intervention of>3 weeks was more effective in the improvement of lower limb motor ability in stroke patients.CONCLUSION:Current evidence suggests that transcranial direct current stimulation has a better therapeutic effect on lower limb motor function,walking ability,and balance in patients with stroke,in which the improvement of lower limb motor function is affected by the patient’s age and duration of the disease,and there is a dose-response relationship between the current intensity,the duration of the daily treatment time,and the cycle of the intervention to

关 键 词：脑卒中 平衡 步行 下肢 运动 功能障碍 经颅直流电刺激 META分析 

分 类 号：R454[医药卫生—治疗学] R318[医药卫生—临床医学] R493