高、低频重复经颅磁刺激治疗帕金森病患者临床功能障碍效果的Meta分析

目的系统评价高、低频率重复经颅磁刺激治疗帕金森患者临床功能障碍的效果。方法计算机检索Cochrane图书馆（2010年第1期）、MEDLINE、EMbase、CBMdisc、CNKI中关于高、低频率重复经颅磁刺激对帕金森病（PD）患者临床功能障碍治疗的随机对照试验（RCT）,同时筛检纳入文献的参考文献。文献检索起止时间均从建库至2010年4月。由2名研究者按纳入与排除标准选择文献、评价质量、提取资料并交叉核对,而后进行Meta分析。结果共纳入8个RCT。2个RCT的Meta分析结果显示,高频重复经颅磁刺激10天后PD患者的临床运动功能障碍的改善与对照组相比差异无统计学意义[WDM=–4.75（–13.73,4.23）]。3个RCT的Meta分析结果表明,低频重复经颅磁刺激治疗1月后对PD患者临床症状的改善与对照组相比差异无统计学意义[WDM=–8.51（–18.48,1.46）]。另外3个RCT的Meta分析结果表明,低频重复经颅磁刺激治疗3个月后PD患者临床功能障碍（神经、行为和情绪状态,临床运动功能,日常生活活动能力）的改善与对照组相比差异有统计学意义[WDM=–5.79（–8.44,–1.13）]。在经颅磁刺激方案选择上,额部或运动皮质部的低频率（≤1Hz）、高强度（≥90%RMT）、多次数（≥3次）、长时间（≥3个月）的重复经颅磁刺激可能对PD患者临床功能障碍改善有积极影响,且具有远期效应。结论 PD患者开展低频长期重复经颅磁刺激治疗可有效改善患者的临床症状和功能障碍。受纳入研究质量与数量限制,上述结果尚待更多高质量研究来证实。

Effectiveness of High-and Low-frequency Repetitive Transcranial Magnetic Stimulation for Treating Dysfunction in Patients with Parkinson's Disease:A Meta-analysis

Objective To evaluate the effectiveness of repetitive transcranial magnetic stimulation（rTMS） for treating dysfunction in patients with Parkinsonˉs disease（PD）.Methods We searched the Cochrane Library（Issue 1,2010）,MEDLINE,EMbase,CBMdisc,and CNKI from the date of the database establishment to April 2010.Randomized controlled trials（RCTs） of rTMS for patients with PD were collected.The quality of the included RCTs was critically appraised and data were extracted by two reviewers independently.Meta-analyses were conducted for the eligible RCTs.Re-sults Eight RCTs were included.The pooled results of the rst 2 RCTs showed that,there was no signi cant difference compared with control group about treating PD patients with clinical motor dysfunction by high-frequency rTMS 10 days later（WMD= ¨C4.75,95%CI ¨C13.73 to 4.23）.The pooled analysis of another 3 studies showed that,no signi cant difference were found about improving symptoms with treatment of low-frequency rTMS for 1 month compared with control group（WDM= ¨C8.51,95%CI ¨C18.48 to 1.46）.The pooled analysis of last 3 studies showed that,patient with treatment of low-frequency rTMS for 3 months,had been signi cantly improved in clinical symptoms such as neurological,behavior and emotional state,clinical motor function,and activities of daily living（WDM= ¨C5.79,95%CI ¨C8.44 to ¨C1.13）.The frontal or motor cortex rTMS manifested as low frequency（ü1Hz）,high intensity（Y90% RMT）,multi-frequency（Y3 times） and long time（Y3 months） had a positive effect on the clinical symptoms of patients with PD and also had a long-term effect.Conclusions rTMS can improve clinical symptoms and dysfunction of the patients with PD.