Chinese Journal of Tissue Engineering Research ›› 2026, Vol. 30 ›› Issue (33): 8802-8810.doi: 10.12307/2026.386
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Wang Dehua1, Liang Chunting1, Cheng Xiaofei1, Li Sihui1, Yao Xiaoduo2, Tang Jiqin3
Received:2025-07-11
Revised:2025-10-15
Online:2026-11-28
Published:2026-06-17
Contact:
Tang Jiqin, Associate professor, Master’s supervisor, College of Continuing Education, Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong Province, China
About author:Wang Dehua, MS candidate, College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong Province, China
Supported by:CLC Number:
Wang Dehua, Liang Chunting, Cheng Xiaofei, Li Sihui, Yao Xiaoduo, Tang Jiqin. Effects of different non-invasive brain stimulation modalities on unilateral spatial neglect after stroke: a network meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2026, 30(33): 8802-8810.
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2.2 纳入文献基本特征 共纳入20篇文献,发表年限为2010-2024年,干预周期为10-28 d,纳入文献涉及低频重复经颅磁刺激(Low-frequency repetitive transcranial magnetic stimulation,LF-rTMS)大脑左侧顶叶(LF-rTMS-P3)、低频重复经颅磁刺激大脑双侧顶叶(LF-rTMS-P3+ P4)、低频重复经颅磁刺激P3左侧(LF-rTMS-P5)、高频重复经颅磁刺激(High-frequency repetitive transcranial magnetic stimulation,HF-rTMS)大脑右侧顶叶(HF-rTMS-P4)、高频重复经颅磁刺激大脑左侧顶叶(HF-rTMS-P3)、高频重复经颅磁刺激大脑第一运动皮质区(HF-rTMS-M1)、连续性θ爆发式经颅磁刺激(Continuous theta burst stimulation,cTBS)大脑左侧顶叶(cTBS-P3)、间歇性θ爆发式经颅磁刺激(Intermittent theta burst stimulation,iTBS)大脑左侧背外侧前额叶皮质(iTBS-F5)、双通道经颅直流电刺激大脑双侧顶叶(tDCS-Dual-P3+P4)、双通道经颅直流电刺激大脑前额及枕叶(tDCS-Dual-FP+OL)、单通道经颅直流电刺激大脑右侧顶叶(tDCS-Single-P4)在内的11项非侵入脑刺激的不同干预方案以及常规治疗,见表2,3。 2.3 偏倚风险评估结果 在纳入20篇文献中,3篇被评为低风险[17,19,28],其余17篇被评为存在一定风险,无高风险文献。13项研究提及随机序列的产生办法,包括随机数字表法、随机信封法等,6项研究仅提及随机二字,具体方法未知,1项研究未提及分组方法[14]。在盲法方面:1项研究为双盲试验[20],7项研究对评估治疗者设盲,2项研究对受试者施盲[17,19]。所有纳入研究均数据完整,不存在结局数据缺失及结果的选择性报道偏倚,见 图2。 2.4 直接Meta分析结果 传统Meta分析共纳入20篇文献[14-33],线段二等分试验、改良Barthel指数、Fugl-Meyer运动功能量表评分3个结局指标的异质性均较高,因此选用随机效应模型;简易精神状态检查量表评分异质性较低,选用固定效应模型。研究结果显示非侵入性脑刺激对各项结局指标的治疗效果均优于常规康复,见表4。 2.5 网状Meta分析结果 2.5.1 线段二等分试验 共有17项研究报道了线段二等分试验,涉及10种干预措施。整体不一致性检验结果显示P=0.74,说明直接与间接比较结果较为一致,网络证据图(图3)显示共形成6个闭环,采用节点劈裂法对局部进行环不一致性检验,发现各组数据P值处于0.22-0.89之间,因此采用一致性模型进行分析。 网状Meta结果显示:单通道经颅直流电刺激大脑右侧顶叶、高频重复经颅磁刺激大脑右侧顶叶、高频重复经颅磁刺激大脑左侧顶叶、低频重复经颅磁刺激大脑左侧顶叶4种干预措施治疗效果优于常规治疗;单通道经颅直流电刺激大脑右侧顶叶优于连续性θ爆发式经颅磁刺激大脑左侧顶叶;其他各个干预措施间比较差异并无统计学意义,见图4。 依据SUCRA对干预措施治疗效果进行排序,结果显示:单通道经颅直流电刺激大脑右侧顶叶(85.7%) > 高频重复经颅磁刺激大脑右侧顶叶(71.1%) > 高频重复经颅磁刺激大脑左侧顶叶(67.0%) > 间歇性θ爆发式经颅磁刺激大脑左侧背外侧前额叶皮质(59.0%) > 低频重复经颅磁刺激大脑双侧顶叶(53.0%) > 低频重复经颅磁刺激大脑左侧顶叶(52.2%) > 双通道经颅直流电刺激大脑双侧顶叶(43.1%) > 低频重复经颅磁刺激P3左侧(34.4%) > 连续性θ爆发式经颅磁刺激大脑左侧顶叶(28.0%) > 常规治疗(5.8%),见 图5。 2.5.2 改良Barthel指数 共有10项研究报道了改良Barthel指数,涉及9种干预措施。整体不一致性检验结果显示P=0.93,说明直接与间接比较结果较为一致,网络证据图(图3)显示形成1个闭环,采用节点劈裂法对局部进行环不一致性检验,结果显示P=0.95,采用一致性模型进行分析。 网状Meta结果显示:连续性θ爆发式经颅磁刺激大脑左侧顶叶、高频重复经颅磁刺激大脑右侧顶叶、双通道经颅直流电刺激大脑双侧顶叶、低频重复经颅磁刺激大脑左侧顶叶、高频重复经颅磁刺激大脑第一运动皮质区、单通道经颅直流电刺激大脑右侧顶叶6种干预措施优于常规治疗;连续性θ爆发式经颅磁刺激大脑左侧顶叶、高频重复经颅磁刺激大脑右侧顶叶、低频重复经颅磁刺激大脑左侧顶叶、高频重复经颅磁刺激大脑第一运动皮质区、单通道经颅直流电刺激大脑右侧顶叶5种干预措施优于低频重复经颅磁刺激P3左侧;连续性θ爆发式经颅磁刺激大脑左侧顶叶、高频重复经颅磁刺激大脑右侧顶叶、低频重复经颅磁刺激大脑左侧顶叶3种干预措施优于双通道经颅直流电刺激大脑前额及枕叶;连续性θ爆发式经颅磁刺激大脑左侧顶叶优于单通道经颅直流电刺激大脑右侧顶叶及高频重复经颅磁刺激大脑第一运动皮质区,其他对照间差异无统计学意义,见图4。 依据SUCRA对干预措施治疗效果进行排序,结果显示:连续性θ爆发式经颅磁刺激大脑左侧顶叶(93.6%)> 高频重复经颅磁刺激大脑右侧顶叶(80.7%)> 双通道经颅直流电刺激大脑双侧顶叶(72.3%)> 低频重复经颅磁刺激大脑左侧顶叶(69.2%)> 高频重复经颅磁刺激大脑第一运动皮质区(50.8%)> 单通道经颅直流电刺激大脑右侧顶叶(42.4%)> 双通道经颅直流电刺激大脑前额及枕叶(24.2%)> 低频重复经颅磁刺激P3左侧(13.2%)>常规治疗(3.7%),见图5。 2.5.3 Fugl-Meyer运动功能量表评分 共7项研究报道了Fugl-Meyer运动功能量表评分,涉及6种干预措施。由于未形成闭环,因此无需进行不一致性检验,见图3。 网状Meta分析结果显示:连续性θ爆发式经颅磁刺激大脑左侧顶叶、单通道经颅直流电刺激大脑右侧顶叶优于常规治疗;连续性θ爆发式经颅磁刺激大脑左侧顶叶优于高频重复经颅磁刺激大脑第一运动皮质区、低频重复经颅磁刺激P3左侧;其他对照间差异无统计学意义,见图4。 依据SUCRA对干预措施治疗效果进行排序,结果显示:连续性θ爆发式经颅磁刺激大脑左侧顶叶(94.2%)> 单通道经颅直流电刺激大脑右侧顶叶(76.2%)> 低频重复经颅磁刺激大脑左侧顶叶(50.8%)> 高频重复经颅磁刺激大脑第一运动皮质区(44.5%)> 低频重复经颅磁刺激P3"
左侧(20.6%)> 常规治疗(13.6%),见图5。 2.5.4 简易精神状态检查量表评分 共7项研究报道了简易精神状态检查量表评分,涉及5种干预措施。由于未形成闭环,因此无需进行不一致性检验,见图3。 网状Meta分析结果显示:单通道经颅直流电刺激大脑右侧顶叶、连续性θ爆发式经颅磁刺激大脑左侧顶叶、低频重复经颅磁刺激大脑左侧顶叶优于常规治疗;单通道经颅直流电刺激大脑右侧顶叶、连续性θ爆发式经颅磁刺激大脑左侧顶叶优于低频重复经颅磁刺激P3左侧;其他对照间差异无统计学意义,见图4。 依据SUCRA对干预措施治疗效果进行排序,结果显示:单通道经颅直流电刺激大脑右侧顶叶(92.5%)> 连续性θ爆发式经颅磁刺激大脑左侧顶叶(75.0%)> 低频重复经颅磁刺激大脑左侧顶叶(55.5%)> 低频重复经颅磁刺激P3左侧(16.6%)> 常规治疗(10.4%),见图5。 2.6 发表偏倚评估 绘制偏倚漏斗图对纳入文献≥10篇的结局指标进行偏倚风险评估。结果显示:针对线段二等分试验,漏斗图内各点分布不均匀,且有部分落在范围外及漏斗底部,提示存在一定的发表偏倚风险及小样本效应;针对改良Barthel指数,各散点均位于漏斗图内且分布较为对称,提示偏倚风险较小,但有样本落在漏斗底部,提示可能存在小样本效应,见图6。 2.7 证据等级评价结果 由于此次研究纳入的大部分文献中存在分配隐藏、盲法描述不清楚的现象,因此对偏倚风险一项全部降级;而线段二等分试验、改良Barthel指数、Fugl-Meyer运动功能量表评分3项的异质性较高,所以对其不一致性降级。结果显示:线段二等分试验、改良Barthel指数、Fugl-Meyer运动功能量表评分3项证据等级均为低级,简易精神状态检查量表评分为中级,见表5。 2.8 不良反应 少数研究提及试验过程中患者耐受良好,没有出现任何不良反应,表明非侵入性脑刺激疗法安全性较高。"
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