非侵入性脑刺激治疗脑卒中后下肢运动功能障碍的网状Meta分析  

Network meta-analysis of non-invasive brain stimulation in the treatment of lower limb motor dysfunction after stroke

作　　者：杨媛媛 周珊珊 成小菲 冯露叶 汤继芹[1] Yang Yuanyuan;Zhou Shanshan;Cheng Xiaofei;Feng Luye;Tang Jiqin(School of Rehabilitation Medicine,Shandong University of Traditional Chinese Medicine,Jinan 250355,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

出　　处：《中国组织工程研究》2026年第4期1008-1018,共11页Chinese Journal of Tissue Engineering Research

基　　金：山东中医药大学科研创新团队基金资助项目(220316),项目参与人:汤继芹;山东省老年医学学会基金(LKJGG2021Z018),项目负责人:汤继芹;山东省中医科技发展计划项目(2017-011),项目负责人:汤继芹。

摘　　要：目的:现有研究中多是基于传统Meta分析研究重复经颅磁刺激、经颅直流电刺激等单一刺激方案对脑卒中患者下肢运动功能障碍的疗效,无法明确何种刺激方案为最优选择。此次研究采用网状Meta分析的方式,系统评价非侵入性脑刺激的不同方案治疗脑卒中后下肢运动功能障碍的临床疗效。方法:检索中国知网、万方、维普、中国生物医学文献数据库、Pub Med、Medline和Web of science数据库,搜集关于非侵入性脑刺激不同方案治疗脑卒中后下肢运动功能障碍的随机对照试验,检索时段为各数据库建库至2024-10-01。对纳入研究进行数据提取,利用Rev Man5.4.1软件进行传统Meta分析并评估纳入研究的质量,Stata 17.0软件进行网状Meta分析。结果:(1)纳入研究39篇,共2 920例患者,涉及常规康复训练、高频重复经颅磁刺激、低频重复经颅磁刺激、间歇性θ爆发刺激、连续性θ爆发刺激、经颅直流电刺激6种治疗方法;(2)网状Meta分析结果显示,高频重复经颅磁刺激、低频重复经颅磁刺激、间歇性θ爆发刺激、经颅直流电刺激在Fugl-Meyer下肢运动功能评定量表方面的效果均优于常规康复训练;(3)在提高Berg平衡量表评分方面,高频重复经颅磁刺激、低频重复经颅磁刺激、间歇性θ爆发刺激与常规康复训练之间差异有显著性意义(P <0.05),高频重复经颅磁刺激与间歇性θ爆发刺激之间差异有显著性意义(P <0.05);(4)在提高患者改良Barthel或Barthel指数中,高频重复经颅磁刺激、低频重复经颅磁刺激、间歇性θ爆发刺激、经颅直流电刺激优于常规康复训练;(5)累积排序图下显示,在Fugl-Meyer下肢运动功能评定量表、Berg平衡量表、改良Barthel或Barthel指数方面,高频重复经颅磁刺激的疗效最好,其次为低频重复经颅磁刺激。结论:高频重复经颅磁刺激、低频重复经颅磁刺激都可以改善脑卒中后患者的下肢运动功能OBJECTIVE:Most of the existing studies are based on traditional Meta-analysis to study the efficacy of single stimulation protocols such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation on lower limb motor dysfunction in stroke patients,and it is not possible to clarify which stimulation protocol is the optimal choice.This study used network meta-analysis to systematically evaluate the clinical efficacy of different regimens of non-invasive brain stimulation in the treatment of lower limb motor dysfunction after stroke.METHODS:CNKI,WanFang,VIP,CBM,PubMed,Medline and Web of Science databases were searched to collect randomized controlled trials on different regimens of non-invasive brain stimulation for lower limb motor dysfunction after stroke from inception to October 1,2024.Data extraction was performed on the included studies.RevMan 5.4.1 software was used for traditional meta-analysis and the quality of the included studies was evaluated.Stata 17.0 software was used for network meta-analysis.RESULTS:(1)A total of 39 studies involving 2920 patients were included,involving 6 treatment methods:conventional rehabilitation training,high-frequency repetitive transcranial magnetic stimulation,low-frequency repetitive transcranial magnetic stimulation,intermittent theta burst stimulation,continuous theta burst stimulation,and transcranial direct current stimulation.(2)The results of network meta-analysis showed that high-frequency repetitive transcranial magnetic stimulation,low-frequency repetitive transcranial magnetic stimulation,intermittent theta burst stimulation,and transcranial direct current stimulation were superior to conventional rehabilitation training in the Fugl-Meyer assessment for lower extremity motor function.(3)In terms of improving Berg balance scale score,high-frequency repetitive transcranial magnetic stimulation,low-frequency repetitive transcranial magnetic stimulation,and intermittent theta burst stimulation were significantly different from convent

关 键 词：脑卒中 非侵入性脑刺激 下肢运动功能 网状Meta分析 系统评价 

分 类 号：R493[医药卫生—康复医学] R318[医药卫生—临床医学] R743.3