阳极经颅直流电刺激对脑卒中后上肢运动功能障碍影响的 Meta 分析

摘要

目的：：系统评价阳极经颅直流电刺激(a-tDCS)对脑卒中患者上肢运动功能恢复的影响。方法：采用计算机检索 Cochrane 图书馆、PubMed、EMbase、CBMdisc、中国知网和万方数据库中关于 a-tDCS 对脑卒中患者上肢运动功能恢复的随机对照试验(RCTs),并对纳入研究的偏倚风险和证据质量进行评价,对符合相同结局指标的RCTs 进行合并数据的 Meta 分析。结果：本研究共纳10篇 RCT。Meta 分析两个主要结局指标的结果显示：a-tDCS 作用于患侧大脑运动皮层后,患者的 Fugl-Meyer 运动评分量表的上肢评分部分与假刺激组相比,其差异无统计学意义[WMD=3.39,95%CI(-2.35,9.13)]；a-tDCS 作用于患侧大脑运动皮层后,患者的 Jebsen-Taylor 手功能测试评分与假刺激组比较,其差异有统计学意义[WMD=-3.01,95%CI(-5.18,-0.85)]。GRADE 系统推荐等级结果提示每个结局均为极低等级。结论：阳极经颅直流电刺激对脑卒中后患者上肢功能的改善有一定的作用,但仍有待开展大样本、多中心、方法科学规范的高质量 RCT,以进一步验证其康复效果。%Objective:To evaluate the effectiveness of anodal transcranial direct current stimulation (tDCS)in trea-ting stroke patients with upper motor dysfunction.Methods:The Cochrane Library,MEDLINE,EMbase,CBMdi-sc,CNKI and Wanfang Data were searched from their inception to January 2014,and the references of the included studies were also retrieved to collect the randomized controlled trials (RCTs)on anodal tDCS in treating stroke pa-tients with upper motor dysfunction.Two reviewers independently screened articles according to the inclusion and exclusion criteria,extracted data and evaluated the quality of the included studies.The meta-analysis was performed using RevMan 5.0 software,and evidence quality and recommendation level were assessed using the GRADE sys-tem.Results:A total of 10 RCTs were included.The results of meta-analysis (including 7 RCTs,very low quality) showed that as compared with the sham tDCS group,the score of JTT in the a-tDCS group undergoing the stimula-tion of the area of primary motor cortex was increased (WMD=-3.01,95% CI -5.18 to -0.85),but the score of upper limb FMA in the a-tDCS group was not increased (WMD=3.39,95% CI -2.35 to 9.13).The two out-comes were all of low quality in the GRADE system.Conclusions:It is apparent from the available studies that a-tDCS may have a certain effect in treating stroke patients with upper motor dysfunction.But more large-sample, multicenter,and high-quality RCTs are required to further proof the effectiveness of a-tDCS in treating stroke pa-tients with limb dysfunction.