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中华脑科疾病与康复杂志(电子版) ›› 2023, Vol. 13 ›› Issue (06) : 327 -334. doi: 10.3877/cma.j.issn.2095-123X.2023.06.002

临床研究

重复经颅磁刺激对脑瘫患儿运动功能康复效果的Meta分析
杨钰琳, 常万鹏, 丁江涛, 徐红莉, 仵宵, 肖伯恒, 马丽虹()   
  1. 250355 济南,山东中医药大学康复医学院
  • 收稿日期:2022-12-09 出版日期:2023-12-15
  • 通信作者: 马丽虹

Effect of repetitive transcranial magnetic stimulation on motor function in children with cerebral palsy: a Meta-analysis

Yulin Yang, Wanpeng Chang, Jiangtao Ding, Hongli Xu, Xiao Wu, Boheng Xiao, Lihong Ma()   

  1. College of Rehabilitation, Shandong University of Traditional Chinese Medicine, Ji'nan 250355, China
  • Received:2022-12-09 Published:2023-12-15
  • Corresponding author: Lihong Ma
  • Supported by:
    The Research Planning Project of Higher Medical Education Research Center of Shandong Province
引用本文:

杨钰琳, 常万鹏, 丁江涛, 徐红莉, 仵宵, 肖伯恒, 马丽虹. 重复经颅磁刺激对脑瘫患儿运动功能康复效果的Meta分析[J/OL]. 中华脑科疾病与康复杂志(电子版), 2023, 13(06): 327-334.

Yulin Yang, Wanpeng Chang, Jiangtao Ding, Hongli Xu, Xiao Wu, Boheng Xiao, Lihong Ma. Effect of repetitive transcranial magnetic stimulation on motor function in children with cerebral palsy: a Meta-analysis[J/OL]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2023, 13(06): 327-334.

目的

系统评价重复经颅磁刺激(rTMS)对脑瘫患儿运动功能的康复疗效。

方法

计算机检索Cochrane Library、PubMed、Web of Science、Google Scholar、中国生物医学数据库、中国知网、维普期刊数据库、万方数据库,筛选关于rTMS改善脑瘫患儿运动功能的随机对照试验,检索时限从建库至2022年10月。按照Cochrane系统评价手册和物理治疗证据数据库量表对纳入文献进行质量评价,采用RevMan 5.4进行Meta分析、亚组分析、敏感性分析及发表偏倚分析。

结果

最终纳入17篇文献,共1283例患者。Meta分析显示,rTMS可显著改善脑瘫患儿粗大运动功能(MD=6.74,95%CI:5.26~8.21,P<0.05)、踝关节活动度(MD=3.38,95%CI:2.87~3.89,P<0.05)、发育商(DQ)(MD=5.62,95%CI:1.62~9.61,P<0.05),但对精细运动功能的改善效果不明显(MD=2.21,95%CI:-0.46~4.89,P>0.05)。以GMGM-88为指标的偏倚风险较低。

结论

rTMS在改善脑瘫患儿粗大运动功能方面和DQ方面具有疗效。

Objective

To systematically evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) on the rehabilitation of motor function in children with cerebral palsy.

Methods

Computer searches of Cochrane Library, PubMed, Web of Science, Google Scholar, China Biomedical Database, China Knowledge Network, Wipro Journal Database, Wanfang Database were conducted to screen randomised controlled trials on rTMS for improvement of motor function in children with cerebral palsy with a timeframe of the search from library construction to October 2022. The quality of the included literature was evaluated according to the Cochrane Handbook for Systematic Evaluation and The Physiotherapy Evidence Database scale, and Meta-analysis, subgroup analysis, sensitivity analysis, and publication bias analysis were performed using RevMan5.4.

Results

Seventeen papers with 1283 patients were finally included. rTMS significantly improved the Gross motor function measure-88 scores (MD=6.74, 95%CI: 5.26-8.21, P<0.05) and ankle mobility scores (MD=3.38, 95%CI: 2.87-3.89, P<0.05), developmental quotient (DQ) score (MD=5.62, 95%CI: 1.62-9.61, P<0.05), but fine motor function measure score (MD=2.21, 95%CI: -0.46-4.89, P>0.05) was not significant. The risk of bias was low when GMGM-88 was used as an indicator.

Conclusion

rTMS is effective in improving gross motor function and DQ in children with cerebral palsy.

图1 文献筛选流程图
Fig.1 Literature screening flow chart
表1 17篇纳入文献的基本特征
Tab.1 Basic characteristics of 17 pieces of included literature
纳入研究 国家 样本量(试验组/对照组) 干预措施 干预时间 测量时间 结局指标
试验组 对照组
Gupta等[11](2016) 印度 15/15 5 Hz的rTMS刺激,15 min/d,持续20 d CRT 20 d 20 d
Gupta等[12](2019) 印度 10/15 5 Hz的rTMS刺激,15 min/d,持续20 d CRT 20 d 20 d
Mahgoub等[13](2021) 埃及 15/15 5 Hz的rTMS刺激,15 min/d,持续20 d CRT 20 d 20 d
陈键蕊[14](2022) 中国 42/39 5 Hz的rTMS刺激,20 min/d,5次/周,持续3个月 CRT 12周 12周
成慧焱[15](2019) 中国 25/25 5 Hz的rTMS刺激,20 min/d,持续2个月 CRT 8周 8周
程春雨和张丽华[16](2017) 中国 40/40 5 Hz的rTMS刺激,20 min/d,持续2个月 CRT 8周 8周
邓艳等[17](2019) 中国 32/32 5 Hz的rTMS刺激,20 min/d,5次/周,持续3个月 CRT 12周 12周
丁德琴[18](2022) 中国 60/60 5 Hz的rTMS刺激,20 min/次,2 d 1次,7 d/1个月,持续6个月 CRT 24周 12周/24周
谷仓[19](2017) 中国 30/30 5 Hz的rTMS刺激,20 min/次,2次/d,持续1个月 CRT 4周 4周
李新剑等[20](2015) 中国 38/37 5 Hz的rTMS刺激,20 min/d,2周/疗程,2个疗程间隔10 d,持续4周 CRT 4周 4周/12周 ①②④
梁玉[21](2020) 中国 40/40 5 Hz的rTMS刺激,30 min/次,2次/d,5 d/周,持续3个月 CRT 12周 12周 ①③
马晓飞和冶慧荣[22](2017) 中国 30/30 10 Hz的rTMS刺激,20 min/d,5 d/周,连续治疗4周、休息1周,持续3个月 CRT 12周 12周
王淑君[23](2013) 中国 30/30 F1~F6变频rTMS刺激,30 min/d,2周/疗程,持续2个疗程,2疗程之间休息3~5 d CRT 4周 4周
王兴宏[24](2017) 中国 34/34 F1~F6变频rTMS刺激,20 min/d,4周/疗程,持续5个疗程,2个疗程之间休息3~5 d CRT 20周 20周
武改[25](2017) 中国 27/27 5 Hz的rTMS刺激,20 min/d,持续4周 CRT 4周 4周 ①③
张丽华[26](2015) 中国 20/20 5 Hz的rTMS刺激,20 min/d,5次/周,持续4周 CRT 4周 2周/4周
张丽华[27](2018) 中国 20/20 5 Hz的rTMS刺激,20 min/d,15 d/疗程,每个疗程之间休息5 d,持续12周 CRT 12周 8周/12周
图2 纳入文献的偏倚风险评价
Fig.2 Assessment diagram of risk of bias included in literature
表2 纳入文献的PEDro量表评分
Tab.2 PEDro scale scores for included studies
图3 rTMS对脑瘫患儿GMFM-88评分的影响
Fig.3 Effect of rTMS on GMFM-88 scores in children with CP
图4 rTMS对脑瘫患儿FMFM评分的影响
Fig.4 Effect of rTMS on FMFM scores in children with CP
图5 rTMS对脑瘫患儿踝关节活动度的影响
Fig.5 Effect of rTMS on ankle mobility in children with CP
图6 rTMS对脑瘫患儿DQ评分的影响
Fig.6 Effect of rTMS on DQscores in children with CP
图7 以GMFM-88为结局指标的发表偏移检测漏斗图
Fig.7 Publish funnel plot of bias detection with GMFM-88 as the ending indicator
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