Chinese Journal of Tissue Engineering Research ›› 2023, Vol. 27 ›› Issue (20): 3274-3280.doi: 10.12307/2023.150
Therapeutic effect of different-frequency repetitive transcranial magnetic stimulations on post-stroke cognitive impairment: a Meta-analysis
Yin Yikun1, 2, Wang Jialin2, Sun Junzhi2
- 1College of Physical and health Education, Guangxi Normal University, Guilin 541004, Guangxi Zhuang Autonomous Region, China; 2Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu 610041, Sichuan Province, China
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Received:2022-01-21Accepted:2022-05-24Online:2023-07-18Published:2022-11-21 -
Contact:Sun Junzhi, PhD, Senior laboratory technician, Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu 610041, Sichuan Province, China -
About author:Yin Yikun, Master candidate, College of Physical and health Education, Guangxi Normal University, Guilin 541004, Guangxi Zhuang Autonomous Region, China; Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu 610041, Sichuan Province, China -
Supported by:the National Key Research and Development Project of China, No. 2019YFF0301704 (to SJZ)
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Yin Yikun, Wang Jialin, Sun Junzhi. Therapeutic effect of different-frequency repetitive transcranial magnetic stimulations on post-stroke cognitive impairment: a Meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2023, 27(20): 3274-3280.
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2.1 纳入文献数量分析 初步检索文献792篇，未通过其他途径获取到文献，经层层筛选后最终得到16篇文献[15-30]。文献筛选流程及结果见图2。"
2.2 纳入研究的基本特征与方法学质量评价结果 纳入16篇文献共涉及847例患者，纳入文献的基本信息见表 1。使用RevMan 5.4软件根据Cochrane系统评价手册对纳入研究进行评价，并根据PEDro量表评分文献质量分级，其中高质量文献占比25%(4篇)，中质量文献占比69% (9篇)，低质量文献占比6%(1篇)。见表 2。"
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2.3 Meta分析结果 2.3.1 各组蒙特利尔认知评估量表评分差异 共11篇文献报道了经重复经颅磁刺激治疗后蒙特利尔认知评估量表评分结果[15-21，24-25，29-30]。研究间异质性：I2=50%，P=0.02，采用随机效应模型，Meta分析结果显示：重复经颅磁刺激组蒙特利尔认知评估量表评分明显高于对照组(MD=3.40，95%CI：2.57-4.24，P < 0.000 1)。 进一步对不同频率对蒙特利尔认知评估量表评分进行亚组分析发现，结果显示：9篇文献报道了高频经颅磁刺激治疗后评分高于对照组(MD=3.57，95%CI：2.55-4.58，P < 0.000 01) [15-21，24-25]；4篇文献报道了低频经颅磁刺激治疗后评分高于对照组(MD=2.94，95%CI：1.53-3.46，P < 0.000 1) [15-16，29-30]，高频刺激后的蒙特利尔认知评估量表评分高于低频刺激，见图3。"
2.3.2 各组简易精神状态量表评分差异 共6篇文献报道了经重复经颅磁刺激治疗后简易精神状态量表评分结果[18，23，26-29]。 研究间异质性：I2=66%，P=0.01，采用随机效应模型进行Meta分析，结果显示：重复经颅磁刺激组简易精神状态量表评分明显高于对照组(MD=2.22，95%CI：0.78-3.65，P=0.002)。进一步对不同频率重复经颅磁刺激进行亚组分析，发现4篇文献报道了高频经颅磁刺激治疗后评分高于对照组(MD=1.70，95%CI：0.11-3.28，P=0.04) [18，23，28-29]；2篇文献报道了低频经颅磁刺激治疗后评分略高于对照组，但差异无显著性意义(MD=3.80，95%CI：-0.10-7.70，P=0.06) [26-27]，低频刺激后的简易精神状态量表评分高于高频刺激，见图4。"
2.3.3 各组听觉事件相关电位(P300潜伏期及波幅)差异 共2篇文献报道了重复经颅磁刺激治疗后P300潜伏期结果[16，19]。 研究间异质性：I2=52%，P=0.12，采用随机效应模型进行Meta 分析，结果显示：重复经颅磁刺激组P300 潜伏期明显低于对照组(MD=-27.11，95%CI：-35.56至-18.66，P < 0.000 1)。进一步对不同频率重复经颅磁刺激进行亚组分析，结果显示：2篇文献报道了高频经颅磁刺激治疗(MD=-25.07，95%CI：-39.96至-10.18，P=0.001 0)[16，19]；有1篇文献报道了低频经颅磁刺激治疗后(MD=-29.90，95%CI： -39.19至-20.61，P < 0.000 1)， 高频与低频重复经颅磁刺激治疗后P300潜伏期均明显低于对照组，低频刺激后的P300潜伏期降低幅度大于高频刺激[16]，见表 3。"
共2篇文献报道了重复经颅磁刺激治疗后P300波幅结果[16，19]。研究间异质性：I2=0%，P=0.64，采用固定效应模型进行 Meta分析，结果显示：重复经颅磁刺激组P300波幅明显高于对照组(MD=1.91，95%CI：1.06-2.76，P < 0.000 1)。进一步对不同频率重复经颅磁刺激进行亚组分析，发现2篇文献报道了高频经颅磁刺激治疗(MD=1.92，95%CI：0.95-2.89，P=0.000 1)[16，19]；1篇文献报道了低频经颅磁刺激治疗(MD=1.90，95%CI：0.15-3.65，P=0.03)，高频与低频治疗后P300波幅均明显高于对照组，高频刺激后的P300波幅高于低频刺激[15]。 2.3.4 各组改良Barthel指数差异比较 有4篇文献报道了重复经颅磁刺激治疗后改良Barthel指数[16-17，21-22]。研究间异质性：I2=49%，P=0.08，采用固定效应模型进行 Meta分析，结果显示：重复经颅磁刺激组改良Barthel指数明显高于对照组(MD=5.95，95%CI：3.94-7.96，P < 0.000 1)。 进一步对不同频率重复经颅磁刺激进行亚组分析，发现有4篇文献报道了高频经颅磁刺激治疗后(MD=7.40，95%CI：4.82-9.97，P < 0.0001) [16-17，21-22]；有2篇文献报道了低频经颅磁刺激治疗后(MD=3.69，95%CI：0.48-6.90，P=0.02)，高频与低频治疗后改良Barthel指数均明显高于对照组[16，22]，见表3。 2.4 发表偏倚及敏感性分析结果 采用Begg’s 和Egger’s检验对以简易精神状态量表(MMSE)评分和蒙特利尔认知评估量表(MoCA)评分为结果指标分析发表偏倚，检验结果显示：此2个指标漏斗图左右侧研究节点不完全对称，见图5。结合Egger’s检验结果显示MoCA(t=-0.34，P=0.737，P > 0.05)、MMSE(t=-0.46，P=0.666，P > 0.05)，说明发表偏倚无显著性差异。"
对纳入文献的Meta分析结果进行逐一剔除法敏感性分析，结果表明剔除后剩余研究指标的综合效应量影响较小，稳定性较好，见图6。"
2.5 纳入研究的GRADE质量评价结果 对纳入研究的关键性结局指标[蒙特利尔认知评估量表评分、简易精神状态量表评分、事件相关电位P300潜伏期和波幅、改良Barthel指数]进行GRADE证据质量评价，GRADE系统将证据质量分为4个等级：高、中、低和极低，并从以下5方面因素：偏倚风险、不一致性、不精确性、间接性和发表偏倚进行评级，其中蒙特利尔认知评估量表评分、改良Barthel指数指标为中等质量证据，具体见表4。"
2.6 安全性分析结果 有4篇文献对不良反应进行了报道[19-21，30]，仅报道1或2例患者出现短暂轻微头痛、头晕现象，患者休息片刻后，症状即可缓解，均未出现其他不良反应，总体说来重复经颅磁刺激安全性良好。"
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