中国组织工程研究

中国组织工程研究 ›› 2026, Vol. 30 ›› Issue (5): 1282-1293.doi: 10.12307/2026.032

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

不同神经调控刺激方式改善帕金森病患者非运动症状的网状Meta分析

冷晓轩1，赵玉欣1，刘西花2   

  1. 1山东中医药大学康复医学院，山东省济南市   250355； 2山东中医药大学附属医院康复科，山东省济南市   250014


  • 收稿日期:2024-12-04 接受日期:2025-02-06 出版日期:2026-02-18 发布日期:2025-06-27
  • 通讯作者: 刘西花，医学博士，主任医师，硕士生导师，山东中医药大学附属医院康复科，山东省济南市 250014
  • 作者简介:冷晓轩，女，2001年生，山东省潍坊市人，汉族，山东中医药大学在读硕士，主要从事心肺和神经康复研究。
  • 基金资助:
    山东省中医药科技项目(M-2023142)，项目负责人：刘西花；山东省医务职工科技创新计划项目(SDYWZGKCJH2022024)，项目负责人：刘西花

Effects of different neuromodulatory stimulation modalities on non-motor symptoms in Parkinson’s patients: a network meta-analysis

Leng Xiaoxuan1, Zhao Yuxin1, Liu Xihua2   

  1. 1College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong Province, China; 2Department of Rehabilitation, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250012, Shandong Province, China
  • Received:2024-12-04 Accepted:2025-02-06 Online:2026-02-18 Published:2025-06-27
  • Contact: Liu Xihua, MD, Chief physician, Master’s supervisor, Department of Rehabilitation, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250012, Shandong Province, China
  • About author:Leng Xiaoxuan, Master candidate, College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong Province, China
  • Supported by:
    Shandong Province Traditional Chinese Medicine Science and Technology Project, No. M-2023142 (to LXH); Shandong Province Medical Staff Science and Technology Innovation Program Project, No. SDYWZGKCJH2022024 (to LXH) 

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摘要：


文题释义：
神经调控技术：是指利用植入或非植入性技术，采用物理(电、磁、光、超声等)或化学手段，对中枢神经系统、周围神经系统和自主神经系统邻近或远隔部位的神经元或神经网络信号的转导发挥兴奋、抑制或调解的作用，从而改善患者生活质量，提高患者神经功能的生物医学工程技术。
帕金森病非运动症状：帕金森病的非运动症状往往比运动症状出现的还要早，表现多样化，主要包括睡眠障碍、抑郁焦虑等症状，严重影响患者的生活质量。

目的：已有研究证实，神经调控技术对帕金森病患者的临床症状有较为明显的改善作用，并且不同神经调控刺激方式之间存在疗效差异。采用网状Meta分析评价不同神经调控技术刺激方式改善帕金森病患者睡眠障碍及抑郁焦虑等非运动症状的疗效，探讨最佳神经调控刺激
方案。
方法：应用计算机检索中国生物医学文献数据库、万方数据库、维普数据库、中国知网及Web of Science、PubMed、The Cochrane Library、EMbase数据库中关于神经调控技术改善帕金森病患者睡眠障碍及抑郁焦虑的随机对照试验，对照组采用常规治疗(药物、常规康复治疗等)或假刺激，试验组在对照组的基础上加用神经调控技术。采用PEDro量表和Cochrane协作网推荐的偏倚风险评估工具对纳入的文献进行质量评价，采用RevMan 5.4和Stata 17.0对4个结局指标(睡眠障碍、焦虑症状、抑郁症状、生活质量)进行网状Meta分析。
结果：①最终纳入29项随机对照试验，涉及6种神经调控刺激方式，包括经颅直流电刺激、高频重复经颅磁刺激、低频重复经颅磁刺激、丘脑底核脑深部电刺激、苍白球内侧脑深部电刺激、多靶点脑深部电刺激。②网状Meta分析结果显示：与常规治疗相比，经颅直流电刺激[SMD=-2.57，95%CI=(-4.52，-0.63)，P < 0.05]在改善帕金森病患者睡眠障碍方面的疗效最佳；在改善帕金森病患者抑郁症状方面，苍白球内侧脑深部电刺激[SMD=-1.00，95%CI=(-1.87，-0.14)，P < 0.05]的疗效最佳，其次为低频重复经颅磁刺激[SMD=-0.91，95%CI=(-1.60，
-0.23)，P < 0.05]、丘脑底核脑深部电刺激[SMD=-0.82，95%CI=(-1.56，-0.08)，P < 0.05]、高频重复经颅磁刺激[SMD=-0.75，95%CI=
(-0.97，-0.53)，P < 0.05]；在改善帕金森病患者焦虑症状方面，高频重复经颅磁刺激[SMD=-0.86，95%CI=(-1.54，-0.18)，P < 0.05]的疗效最佳；在改善患者生活质量方面，苍白球内侧脑深部电刺激[SMD=-0.79，95%CI=(-1.55，-0.04)，P < 0.05]的疗效最佳，其次为高频重复经颅磁刺激[SMD=-0.63，95%CI=(-0.90，-0.36)，P < 0.05]、经颅直流电刺激[SMD=-0.50，95%CI=(-0.80，-0.19)，P < 0.05]。
结论：神经调控技术在改善帕金森病患者非运动症状方面具有显著疗效，其中，经颅直流电刺激改善睡眠障碍的疗效最佳，苍白球内侧脑深部电刺激改善抑郁症状的疗效最佳，高频重复经颅磁刺激改善焦虑症状的疗效最佳，苍白球内侧脑深部电刺激改善生活质量的疗效最佳。

https://orcid.org/0009-0003-6268-8824 (冷晓轩) 


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, 神经调控技术, 经颅直流电, 重复经颅磁刺激, 脑深部电刺激, 睡眠障碍, 抑郁, 焦虑, 生活质量, 网状Meta分析, 工程化组织构建

Abstract: OBJECTIVE: It has been confirmed that neuromodulation technology can improve the clinical symptoms of patients with Parkinson’s disease, and there are differences in the efficacy of different neuromodulation stimulation methods. Herein, a network meta-analysis was used to evaluate the efficacy of different neuromodulation stimulation modalities in improving non-motor symptoms such as sleep disorders and depression and anxiety in patients with Parkinson’s disease, thereby exploring the optimal neuromodulation stimulation regimen.
METHODS: The Chinese Biomedical Literature Database, WanFang Database, VIP Database, CNKI Database, Web of Science, PubMed, The Cochrane Library, and EMbase databases were searched for randomized controlled trials on neuromodulation techniques to improve sleep disorders, depression and anxiety in patients with Parkinson’s disease. The control group was treated with conventional treatments (drugs, conventional rehabilitation therapy, etc.) or sham stimulation, and the experimental group was supplemented with neuromodulation technology on the basis of the control group. The quality of the included studies was evaluated using the PEDro scale and the deviation risk assessment tool recommended by the Cochrane Collaboration. RevMan 5.4 and Stata 17.0 were used for network meta-analysis of the four outcomes (sleep disorders, anxiety symptoms, depressive symptoms, and quality of life).
RESULTS: (1) Twenty-nine randomized controlled trials involving six neuromodulation stimulation modalities were included. These modalities were transcranial direct current stimulation, high-frequency repetitive transcranial magnetic stimulation, low-frequency repetitive transcranial magnetic stimulation, deep brain stimulation of the subthalamic nucleus, deep brain stimulation of the globus pallidus, multi-target deep brain stimulation. (2) The results of network meta-analysis showed that compared with conventional treatment, transcranial direct current stimulation [standardized mean difference (SMD)=-2.57, 95% confidence interval (CI)=-4.52 to -0.63, P < 0.05) had the best effect in improving sleep disorders in patients with Parkinson’s disease. In terms of improving depressive symptoms, deep brain stimulation of the globus pallidus (SMD=-1.00, 95% CI=-1.87 to -0.14, P < 0.05) had the best effect, followed by low-frequency repetitive transcranial magnetic stimulation (SMD=-0.91, 95%CI=-1.60 to -0.23, P < 0.05), deep brain stimulation of the subthalamic nucleus (SMD=-0.82, 95% CI=-1.56 to -0.08, P < 0.05), and high-frequency repetitive transcranial magnetic stimulation (SMD=-0.75, 95% CI=-0.97 to -0.53, P < 0.05). In terms of improving anxiety symptoms, high-frequency repetitive transcranial magnetic stimulation (SMD=-0.86, 95% CI=-1.54 to -0.18, P < 0.05) had the best effect. In terms of improving the quality of life, deep brain stimulation of the globus pallidus (SMD=-0.79, 95% CI=-1.55 to -0.04, P < 0.05) had the best efficacy, followed by high-frequency repetitive transcranial magnetic stimulation (SMD=-0.63, 95% CI=-0.90 to -0.36, P < 0.05) and transcranial direct current stimulation (SMD=-0.50, 95% CI=-0.80 to -0.19, P < 0.05). 
CONCLUSION: Neuromodulation technology has significant efficacy in improving non-motor symptoms in patients with Parkinson’s disease. Transcranial direct current stimulation has the best efficacy in improving sleep disorders, deep electrical stimulation of the medial cerebral part of the globus pallidus has the best efficacy in improving depressive symptoms, high-frequency repetitive transcranial magnetic stimulation has the best efficacy in improving anxiety symptoms, and deep electrical stimulation of the globus pallidus has the best efficacy in improving quality of life.

Key words: Parkinson’s disease, neuromodulation techniques, transcranial direct current, repetitive transcranial magnetic stimulation, deep brain stimulation, sleep disorder, depression, anxiety, quality of life, network meta-analysis, engineered tissue construction

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