中国组织工程研究

中国组织工程研究 ›› 2026, Vol. 30 ›› Issue (18): 4749-4762.doi: 10.12307/2026.739

• 组织构建循证医学 evidence-based medicine in tissue construction • 上一篇    

不同非侵入性脑刺激方案对帕金森病患者步态和平衡功能影响的网状Meta分析

成小菲1，杨媛媛1，李思慧1，王德花1，梁春婷1，李佳蔚1，姚明阳1，姚筱朵3，汤继芹2   

  1. 山东中医药大学，1康复医学院，2继续教育学院，山东省济南市  250355；3山东第二医科大学康复医学院，山东省潍坊市  261042
  • 收稿日期:2025-07-09 接受日期:2025-09-17 出版日期:2026-06-28 发布日期:2025-12-11
  • 通讯作者: 汤继芹，副教授，硕士研究生导师，山东中医药大学继续教育学院，山东省济南市 250355
  • 作者简介:成小菲，女，1999年生，甘肃省陇南市人，山东中医药大学在读硕士，主要从事脑功能康复的临床与基础研究。
  • 基金资助:
    山东省中医药科技发展项目(2017-011)，项目负责人：汤继芹；山东省老年医学学会基金(LKJGG2021Z018)，项目负责人：汤继芹；山东中医药大学科研创新团队基金项目(220316)，项目参与人：汤继芹

Effects of different non-invasive brain stimulation protocols on gait and balance function in patients with Parkinson’s disease: a network meta-analysis

Cheng Xiaofei1, Yang Yuanyuan1, Li Sihui1, Wang Dehua1, Liang Chunting1, Li Jiawei1, Yao Mingyang1, Yao Xiaoduo3, Tang Jiqin2     

  1. 1Rehabilitation Medical College, 2Continuing Education College, Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong Province, China; 3Rehabilitation Medical College of Shandong Second Medical University, Weifang 261042, Shandong Province, China
  • Received:2025-07-09 Accepted:2025-09-17 Online:2026-06-28 Published:2025-12-11
  • Contact: Tang Jiqin, Associate professor, Master’s supervisor, Continuing Education College, Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong Province, China
  • About author:Cheng Xiaofei, MS candidate, Rehabilitation Medical College, Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong Province, China
  • Supported by:
    Shandong Provincial Traditional Chinese Medicine Science and Technology Development Project, No. 2017-011 (to TJQ); Shandong Provincial Geriatric Medicine Association Fund, No. LKJGG2021Z018 (to TJQ); Shandong University of Traditional Chinese Medicine Scientific Research Innovation Team Fund Project, No. 220316 (to TJQ)

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摘要：


文题释义：
非侵入性脑刺激：利用电磁、声波等物理特性的外部设备作用于颅外或大脑皮质的神经调控技术，可以间接影响大脑的神经活动。常见的代表性方法包括经颅磁刺激和经颅直流电刺激。
帕金森病：是一种主要影响中老年人的慢性神经退行性疾病，患者可能会出现严重的非器质性症状，以运动障碍为核心，同时伴随多种非运动症状，其主要病理特征是中脑黑质多巴胺能神经元的进行性丧失，导致神经递质多巴胺严重不足，进而引发运动控制异常。

目的：通过网状Meta分析整合直接与间接证据，比较不同非侵入性脑刺激技术及参数对帕金森病患者步态和平衡功能的影响，并排序最佳干预方案。
方法：检索CNKI、万方、维普、CBM、PubMed、Cochrane图书馆、EMbase和Web of Science数据库，筛选有关非侵入性脑刺激改善帕金森病患者步态和平衡障碍的随机对照试验，检索时限截止到2025-06-16。对纳入的研究进行数据提取，采用RevMan 5.4.1软件和Stata 17.0软件进行统计学处理。
结果：①纳入47篇研究，共2 767例患者，试验组1 399例、对照组1 368例；②传统Meta分析结果显示，高频重复经颅磁刺激可以降低统一帕金森病评定量表第三部分(UPDRSⅢ)评分、冻结步态问卷(FOG-Q)评分，缩短起立-行走计时试验(TUGT)时间，增加步长，改善步速，提高Berg平衡量表评分，且均优于常规治疗(P < 0.05)；经颅直流电刺激可以降低冻结步态问卷评分、缩短起立-行走计时试验时间，增加步长，改善步速，提高Berg平衡量表评分，且均优于常规治疗(P < 0.05)；低频重复经颅磁刺激可以降低统一帕金森病评定量表第三部分评分，与常规治疗比较有显著性差异(P < 0.05)；3种脑刺激方法对于步频的改善均无统计学意义(P > 0.05)，受限于研究数量少，需进一步验证；③网状Meta分析结果显示(以下排序均基于间接比较)，在降低统一帕金森评定量表第三部分评分方面：高频重复经颅磁刺激选择初级运动皮质区(M1)+背外侧前额叶皮质区(DLPFC)双侧靶点联合刺激的累积概率排序最高(95.2%)，在初级运动皮质区上刺激排序次之(72.5%)；在缩短起立-行走计时试验时间方面：高频重复经颅磁刺激在背外侧前额叶皮质区刺激的累积概率排序最高(85.5%)，在初级运动皮质区上刺激排序次之(69.0%)；在改善步速方面：高频重复经颅磁刺激在背外侧前额叶皮质区的累积概率排序最高(92.5%)，在初级运动皮质区上刺激排序次之(76.7%) ；在提高Berg平衡量表评分方面：高频重复经颅磁刺激在初级运动皮质区上刺激的累积概率排序最高(79.9%)，经颅直流电刺激在小脑上刺激排序次之(79.8%)；④GRADE证据质量评价结果显示，统一帕金森评定量表第三部分、冻结步态问卷评分、起立-行走计时试验、步长证据等级为中级，步速、步频、Berg平衡量表评分为低级。
结论：不同类型非侵入性脑刺激都可以改善帕金森病患者的步态和平衡功能。背外侧前额叶皮质区靶向的高频重复经颅磁刺激对步态功能的改善优于初级运动皮质(中等证据)，而初级运动皮质靶向的高频重复经颅磁刺激对平衡功能的改善优于小脑靶向的经颅直流电刺激(低级证据)。

https://orcid.org/0009-0005-1864-8408(成小菲)

中国组织工程研究杂志出版内容重点：干细胞；骨髓干细胞；造血干细胞；脂肪干细胞；肿瘤干细胞；胚胎干细胞；脐带脐血干细胞；干细胞诱导；干细胞分化；组织工程

关键词: 帕金森病, 非侵入性脑刺激, 步态, 平衡功能, 网状Meta分析, 随机对照试验

Abstract: OBJECTIVE: Through a network meta-analysis integrating direct and indirect evidence, this study compared the effects of different non-invasive brain stimulation techniques and parameters on gait and balance functions of patients with Parkinson’s disease, and ranked the best intervention schemes.
METHODS: A literature search of CNKI, WanFang, VIP, CBM, PubMed, Cochrane Library, Embase and Web of Science was conducted to screen the randomized controlled trials related to non-invasive brain stimulation for gait and balance disorders in patients with Parkinson’s disease. The search time limit was up to June 16, 2025. Data of the included studies were extracted for statistical processing using RevMan 5.4.1 software and Stata 17.0 software.
RESULTS: (1) A total of 47 trials were conducted, involving 2 767 patients (1 399 in the trial group and 1 368 in the control group). (2) The results of traditional meta-analysis indicated that high-frequency repetitive transcranial magnetic stimulation could reduce the scores on the third part of the Unified Parkinson’s Disease Rating Scale and the Freezing of Gait Questionnaire, shorten the Timed Up and Go Test time, increase step length, improve gait speed, and raise the Berg Balance Scale score, all of which were superior to conventional treatment (P < 0.05). Transcranial direct current stimulation could lower the Freezing of Gait Questionnaire score, shorten the Timed Up and Go Test time, increase step length, improve gait speed, and raise the Berg Balance Scale score, all of which were superior to conventional treatment (P < 0.05). Low-frequency repetitive transcranial magnetic stimulation could reduce the Unified Parkinson’s Disease Rating Scale III score, and there was a significant difference compared with conventional treatment (P < 0.05). There was no statistically significant improvement in step frequency for all three methods (P > 0.05); however, due to the small number of studies, further verification is required. (3) The results of the network Meta-analysis indicated that in terms of reducing the Unified Parkinson’s Disease Rating Scale III score: high-frequency repetitive transcranial magnetic stimulation targeting bilateral regions of the primary motor cortex and dorsolateral prefrontal cortex produced cumulative probability ranking is the highest (95.2%), followed by stimulation on the primary motor cortex (72.5%); in terms of shortening the Timed Up and Go Test time: high-frequency repetitive transcranial magnetic stimulation produced cumulative probability ranking was the highest on the dorsolateral prefrontal cortex (85.5%), followed by stimulation on the primary motor cortex (69.0%); in terms of improving gait speed: high-frequency repetitive transcranial magnetic stimulation produced cumulative probability ranking was the highest on the dorsolateral prefrontal cortex (92.5%), followed by stimulation on the primary motor cortex (76.7%); in terms of increasing the Berg Balance Scale score: high-frequency repetitive transcranial magnetic stimulation produced cumulative probability ranking was the highest on the primary motor cortex (79.9%), followed by transcranial direct current stimulation on the cerebellum (79.8%). (4) The GRADE evidence quality assessment results show that the evidence levels for the Unified Parkinson’s Disease Rating Scale III, Freezing of Gait Questionnaire score, Timed Up and Go Test time, and stride length were moderate, while those for gait speed, step frequency, and Berg Balance Scale score were low.
CONCLUSION: Different types of non-invasive brain stimulation can all improve the gait and balance functions of patients with Parkinson’s disease. High-frequency repetitive transcranial magnetic stimulation targeting the dorsolateral prefrontal cortex is superior to that targeting the primary motor cortex in improving gait function (moderate evidence), high-frequency repetitive transcranial magnetic stimulation targeting the primary motor cortex is superior to transcranial direct current stimulation targeting the cerebellum in improving balance function (low-level evidence).

Key words: Parkinson’s disease, non-invasive brain stimulation, gait, balance function, network meta-analysis, randomized controlled trial

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