中国组织工程研究

中国组织工程研究 ›› 2026, Vol. 30 ›› Issue (28): 7485-7493.doi: 10.12307/2026.820

• 组织构建循证医学 evidence-based medicine in tissue construction • 上一篇    下一篇

非侵入性神经调控技术对脑卒中后失语患者言语功能影响的网状Meta分析

李思慧1，王  芹2，崔慎红2，成小菲1，冯梓芸2，王德花1，梁春婷1，冷  军2   

  1. 1山东中医药大学康复医学院，山东省济南市  250355；2山东中医药大学第二附属医院康复医院，山东省济南市  250355
  • 收稿日期:2025-09-10 修回日期:2025-12-08 出版日期:2026-10-08 发布日期:2026-02-27
  • 通讯作者: 冷军，博士，主任医师，硕士生导师，山东中医药大学第二附属医院康复医院，山东省济南市 250355
  • 作者简介:李思慧，女，1999年生，广西壮族自治区柳州市人，山东中医药大学在读硕士，主要从事脑、脊髓损伤康复的临床研究。
  • 基金资助:
    2024年度山东省重点研发计划(重大科技创新工程)项目“人机交互脑机接口传感器研发与应用项目” (2024CXGC010603)，项目负责人：冷军；山东省中医药科技项目(M2023102)，项目负责人：王芹

A network meta-analysis of effects of non-invasive neuromodulation techniques on language function in patients with aphasia after stroke

Li Sihui1, Wang Qin2, Cui Shenhong2, Cheng Xiaofei1, Feng Ziyun2, Wang Dehua1, Liang Chunting1, Leng Jun2   

  1. 1Rehabilitation Medical College of Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong Province, China; 2Rehabilitation Hospital of Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong Province, China
  • Received:2025-09-10 Revised:2025-12-08 Online:2026-10-08 Published:2026-02-27
  • Contact: Leng Jun, MD, Chief physician, Master’s supervisor, Rehabilitation Hospital of Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong Province, China
  • About author:Li Sihui, MS candidate, Rehabilitation Medical College of Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong Province, China
  • Supported by:
    2024 Shandong Provincial Key Research and Development Program (Major Scientific and Technological Innovation Project) Program, No. 2024CXGC010603 (to LJ); Shandong Provincial Traditional Chinese Medicine Science and Technology Project, No. M2023102 (to WQ) 

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摘要：



文题释义：
非侵入性神经调控技术：是一种通过物理手段从体外对大脑神经活动进行调控的技术，利用大脑突触的可塑性诱导大脑功能网络重塑，主要包括重复经颅磁刺激和经颅直流电刺激，具有可调节性和空间定位性等优势。
非流畅性失语：是失语症中较常见的类型，占失语症的41.25%，与左侧大脑半球额下回病变密切相关，核心特征为言语生成费力、语量匮乏、停顿频繁等特点。非流畅性失语的临床类型多样，包含运动性失语、经皮质运动性失语、完全性失语等。

目的：大量研究表明，非侵入性神经调控技术能够有效改善脑卒中后非流畅性失语的症状，然而，针对该类技术的最优刺激方案仍有待深入验证与探究。此次研究借助网状Meta分析方法，系统评价不同非侵入性神经调控技术改善脑卒中后非流畅性失语患者言语功能的效应。
方法：检索CNKI、万方、维普、CBM、PubMed、Cochrane图书馆、Embase和Web of Science数据库，筛选有关非侵入性神经调控技术治疗脑卒中后非流畅性失语的随机对照试验，检索时限截至2025-06-01。对照组采用常规治疗或假刺激，试验组在对照组治疗的基础上加入非侵入性神经调控技术，结局指标为西方失语成套测验、汉语失语成套测验、日常生活交流能力评定量表。采用Stata 17.0软件对结局指标进行传统Meta分析和网状Meta分析，采用GRADE对结局指标进行证据等级评价。
结果：共纳入33篇随机对照试验，涉及10种非侵入性神经调控方式。①传统Meta分析结果显示，低频重复经颅磁刺激右侧Broca区、经颅直流电刺激双侧Broca区、经颅直流电刺激左侧Broca区可改善患者西方失语成套测验评分(P < 0.001)，低频重复经颅磁刺激右侧Broca区、低频重复经颅磁刺激颞上回后部、低频重复经颅磁刺激右侧Broca区联合高频重复经颅磁刺激左侧Broca区可改善患者汉语失语成套测验评分(P < 0.05)，低频重复经颅磁刺激右侧Broca区、经颅直流电刺激双侧Broca区、连续性θ爆发刺激右侧Broca区联合间歇性θ爆发刺激左侧Broca区、高频重复经颅磁刺激刺激右侧Broca区、低频重复经颅磁刺激右侧Broca区联合高频刺激左侧Broca区可改善患者日常生活交流能力评定量表评分(P < 0.05)。②网状Meta分析结果显示，低频重复经颅磁刺激右侧Broca区改善患者西方失语成套测验评分和汉语失语成套测验评分的疗效更佳[SMD=1.13，95%CI(0.59，1.67)，P < 0.05；SMD=4.73，95%CI(1.28，8.18)，P < 0.05]，经颅直流电刺激双侧Broca区在改善患者日常生活交流能力评定量表评分的疗效更佳[SMD=1.81，95%CI(0.51，2.12)，P < 0.05]。③GRADE证据等级评价结果显示，西方失语成套测验、汉语失语成套测验、日常生活交流能力评定量表结局指标的证据等级均为低级。
结论：不同非侵入性神经调控方式均能改善脑卒中后非流畅性失语患者的言语功能，低频重复经颅磁刺激右侧Broca区在改善多维度言语功能方面，尤其在自发言语连贯性、听觉理解准确性及命名流畅性等方面疗效显著；经颅直流电刺激双侧Broca区更侧重改善患者的日常生活交流能力，但研究结果受纳入研究的数量及质量影响，证据等级较低，仍需更多高质量的研究进一步验证。 
https://orcid.org/0009-0007-2259-8057(李思慧)


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: 脑卒中, 非流畅性失语, 非侵入性神经调控技术, 言语功能, 经颅直流电刺激, 重复经颅磁刺激, 网状Meta分析

Abstract: OBJECTIVE: Many studies have shown that non-invasive neuromodulation techniques can effectively improve the symptoms of non-fluent aphasia after stroke. However, the optimal stimulation protocols for these techniques still need to be further verified and explored. This article used a network meta-analysis method to systematically evaluate the effects of different non-invasive neuromodulation techniques on improving the language function of patients with non-fluent aphasia after stroke.
METHODS: The CNKI, WanFang, VIP, CBM, PubMed, Cochrane Library, Embase, and Web of Science databases were searched for randomized controlled trials on the treatment of non-fluent aphasia after stroke with non-invasive neural modulation techniques, with the search ending on June 1, 2025. The control group received conventional treatment or sham stimulation, while the trial group received non-invasive neural modulation techniques in addition to the control group’s treatment. The outcome indicators were the western aphasia battery, aphasia battery of Chinese, and activity of daily living scale. The outcome measures were analyzed using both traditional meta-analysis and network meta-analysis with Stata 17.0 software, respectively. The GRADE methodology was employed to evaluate the quality of evidence pertaining to the outcome measures.
RESULTS: A total of 33 randomized controlled trials were included, involving 10 types of non-invasive neuromodulation techniques. (1) Traditional meta-analysis results showed that, low-frequency repetitive transcranial magnetic stimulation of the right Broca’s area, transcranial direct current stimulation of both Broca’s area, and transcranial direct current stimulation of the left Broca’s area improved patients’ scores on the western aphasia battery (P < 0.001). Low-frequency repetitive transcranial magnetic stimulation of the right Broca’s area, low-frequency repetitive transcranial magnetic stimulation of the posterior superior temporal gyrus, and low-frequency repetitive transcranial magnetic stimulation of the right Broca’s area combined with high-frequency repetitive transcranial magnetic stimulation of the left Broca’s area improved patients’ scores on aphasia battery of Chinese (P < 0.05). Low-frequency repetitive transcranial magnetic stimulation of the right Broca’s area, transcranial direct current stimulation of both Broca’s areas, continuous theta burst stimulation of the right Broca’s area combined with intermittent theta burst stimulation of the left Broca’s area, high-frequency repetitive transcranial magnetic stimulation of the right Broca’s area, and low-frequency repetitive transcranial magnetic stimulation of the right Broca’s area combined with high-frequency stimulation of the left Broca’s area all improved patients’ scores on the activity of daily living scale (P < 0.05). (2) The network meta-analysis results showed that low-frequency repetitive transcranial magnetic stimulation of the right Broca’s area was more effective in improving the scores of the western aphasia battery and aphasia battery of Chinese [SMD=1.13, 95%CI(0.59, 1.67), P < 0.05; SMD=4.73, 95%CI(1.28, 8.18), P < 0.05], while transcranial direct current stimulation of the bilateral Broca’s areas was more effective in improving the scores of the activity of daily living scale [SMD=1.81, 95%CI(0.51, 2.12), P < 0.05]. (3) The GRADE evidence level assessment results showed that the evidence levels for the western aphasia battery, aphasia battery of Chinese, and activity of daily living scale were all low. 
CONCLUSION: Different non-invasive neuromodulation techniques can improve speech function in patients with non-fluent aphasia after stroke. Low-frequency repetitive transcranial magnetic stimulation of the right Broca’s area is significantly effective in improving multidimensional speech function, especially in spontaneous speech coherence, auditory comprehension accuracy, and naming fluency. Bilateral transcranial direct current stimulation of the Broca’s area focuses more on improving patients’ daily communication ability. However, the results are affected by the number and quality of included studies, and the level of evidence is low. More high-quality studies are needed to further verify these findings.

Key words: stroke, non-fluent aphasia, non-invasive neuromodulation technique, language function, transcranial direct current stimulation, repetitive transcranial magnetic simulation, network meta-analysis 

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