标题：不同方案非侵入性脑刺激治疗脑卒中后失语症疗效的网状Meta分析

      作者：张楠 1，王振宇 1，刘睿姝 2，郭佳洵 1，张瑞涵 1，黄云霞 1    重庆医科大学附属永川医院康复医学科 1、皮肤科 2，重庆 402160

      卷次： 2021年32卷13期

      【摘要】 目的 系统评价低频重复经颅磁、高频重复经颅磁、经颅直流电刺激等不同类型的非侵入脑刺激对脑卒中后失语症的治疗效果。方法 检索中国知网(CNKI)、万方数据知识服务平台、维普网(VIP)、PubMed、EMBase、Cochrane Library等中外文献数据库，检索时间为建库至 2020年9月。采用 RevMan 5.3、ADDIS 1.16.8软件进行数据合并及网状Meta分析。结果 最终纳入15项研究，共1 058例患者，涉及干预措施共7种；传统Meta分析结果显示常规治疗联合低频重复经颅磁刺激、常规治疗联合经颅直流电刺激的疗效优于单纯常规治疗；网状Meta分析结果显示，除高频 rTMS(右侧)+常规、假 rTMS刺激+常规外，高频 rTMS(左侧)+常规、低频 rTMS+常规、双侧 rTMS+常规、tDCS+常规均优于常规治疗组；概率分布显示高频 rTMS(左侧)+常规在治疗脑卒中失语疗效方面成为最佳方案的概率最大。结论 非侵入性脑刺激对脑卒中后失语症的治疗具有一定程度的辅助作用,其中作用于左侧大脑半球的高频重复经颅磁刺激的疗效最佳。
      【关键词】 失语；脑卒中；非侵入性脑刺激；经颅磁刺激；经颅直流电刺激
      【中图分类号】 R743.3 【文献标识码】 A 【文章编号】 1003—6350（2021）13—1755—07

Effects of different non-invasive brain stimulation treatment for post-stroke aphasia: a network meta-analysis.ZHANG Nan 1, WANG Zhen-yu 1, LIU Rui-shu 2, GUO Jia-xun1, ZHANG Rui-han 1, HUANG Yun-xia 1.
Department ofRehabilitation Medicine 1, Department of Dermatology 2, Yongchuan Hospital of Chongqing Medical University, Chongqing,402160, CHINA
【Abstract】 Objective To systematically evaluate the effects of different types of non-invasive brain stimula-tion such as low frequency repetitive transcranial magnetic stimulation (rTMS), high frequency rTMS, and transcranialdirect current stimulation (tDCS) on the treatment of post-stroke aphasia. Methods Chinese and foreign literature data-bases were searched, including China National Knowledge Infrastructure (CNKI), Wanfang database, VIP database,PubMed, EMbase, and Cochrane Library, relevant articles published up to September 2020. RevMan 5.3 and ADDIS1.16.8 software were used for data merging and network Meta-analysis. Results Finally, 15 studies were included, witha total of 1 058 patients, involving 7 types of interventions. The results of traditional Meta-analysis showed that conven-tional therapy combined with low frequency rTMS, and conventional therapy combined with tDCS were both better thanconventional therapy alone. The results of network meta-analysis showed that, except for combined measurements ofhigh frequency rTMS (right) and conventional treatment, as well as sham rTMS and conventional treatment, the oth-er measurement combinations were all better than conventional treatment group, such as high frequency rTMS (left)combined with conventional treatment, low frequency rTMS and conventional treatment, bilateral rTMS and conven-tional treatment, and tDCS with conventional treatment. The probability distribution showed that high frequency rT-MS (left) with conventional treatment had the greatest probability of being the best treatment for post-stroke apha-sia. Conclusion Non-invasive brain stimulation has a certain degree of auxiliary effect in the treatment ofpost-stroke aphasia, among which high frequency repetitive transcranial magnetic stimulation acting on the left hemi-sphere has the best effect.
      【Key words】 Aphasia; Stroke; Non-invasive brain stimulation; Transcranial magnetic stimulation; Transcranialdirect current stimulation·荟萃分析·doi:10.3969/j.issn.1003-6350.2021.13.035基金项目：国家自然科学基金面上项目(编号：81674066)；重庆科委科技计划项目(编号：cstc2017jcyjAX0397)