周亮,郭志伟,蒋炳虎,等.重复经颅磁刺激治疗轻度认知障碍疗效的Meta分析[J].中华物理医学与康复杂志,2020,42(6):562-569
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| 重复经颅磁刺激治疗轻度认知障碍疗效的Meta分析 |
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| DOI：10.3760/cma.j.issn.0254-1424.2020.06.020 |
| 中文关键词: 经颅磁刺激 轻度认知障碍 情景记忆 Meta分析 |
| 英文关键词: Transcranial magnetic stimulation Cognitive impairment Episodic ability Meta-analyses |
| 基金项目:四川省卫健委课题（18PJ135）；南充市科技局市校合作项目（18SXHZ0434）；川北医学院科研发展计划项目（CBY17-A-YB07） |
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| 中文摘要: |
| 目的 探讨重复经颅磁刺激（rTMS）对轻度认知障碍（MCI）患者的认知改善作用。 方法 检索2019年3月之前所有已发表在PubMed、Cochrane Library、Embase、Web of Science、中国知网、万方数据和维普数据库的有关rTMS治疗MCI患者的随机对照试验研究文献，筛查纳入9篇文献368例MCI患者，利用系统评价Meta分析方法合并认知功能、情景记忆能力、词语流畅性、脑电图P300参数结局变量。 结果 与伪刺激相比，rTMS刺激能有效改善MCI患者的总体认知功能蒙特利尔认知评估量表（MoCA）评分（SMD=1.54,P=0.0009）、情景记忆能力（SMD=0.78,P＜0.0001）、词语流畅性（MD=2.08, P=0.01），降低MCI患者脑电图顶中线区（Pz）的P300潜伏期（SMD=-0.44,P=0.02）和增加P300波幅（SMD=2.04,P＜0.00001）。但与伪刺激相比，rTMS治疗对MCI患者记忆商的改变差异无统计学意义（SMD=0.43, P=0.28）；rTMS联合盐酸多奈哌齐与单独使用盐酸多奈哌齐相比，对MCI患者记忆商（SMD=0.32, P=0.33）和P300潜伏期（SMD=-0.14, P=0.68）差异无统计学意义（P＞0.05）。rTMS具有较好的耐受性，虽然相对对照组而言，rTMS治疗组较易出现不良反应（RR=2.20,P=0.005），但不良反应主要表现为轻微头晕、头皮疼痛等，且大多在1~2 h内缓解，无明显其它不良反应。 结论 rTMS治疗可以有效改善MCI患者的认知功能和情景记忆能力，且具有较好的耐受性。 |
| 英文摘要: |
| Objective To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on the cognition of patients with mild cognitive impairment (MCI). Methods The PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang, and VIP databases were searched for randomized controlled trials of rTMS treating MCI patients before March 2019. After screening the literature, extracting the data and two independent reviewers evaluating the quality of the included studies, the meta-analysis was conducted using version 5.3 of the RevMan software. Results Nine studies covering 368 patients were included. The pooled results showed that compared with sham stimulation, rTMS treatment could effectively improve the cognitive ability (assessed using the Montreal instrument), episodic memory, verbal fluency and the amplitude of MCI patients′ P300 signals. P300 latency was also reduced. However, there was no significant difference, on average, in memory quotient or P300 latency between patients given rTMS plus donepezil hydrochloride and those given donepezil hydrochloride alone. Compared with the control groups, the rTMS treatment groups displayed slightly more frequent adverse reactions, mainly mild dizziness and scalp pain which disappeared within 1-2 hours without obvious residual effects. Conclusions TMS treatment can effectively improve cognitive and memory function. |
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