作者：胡填1，王陶陶1，古剑雄2，向云3

单位：

1.523000广东省东莞市，广东医科大学医学技术学院　2.524000广东省湛江市，广东医科大学附属医院康复医学科3.610000四川省成都市，成都体育学院运动康复教研室

Units：

1.School of Medical Technology, Guangdong Medical University, Dongguan 523000, China2.Department of Rehabilitation Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, China3.Department of Sports Rehabilitation, Chengdu Sport University, Chengdu 610000, China

关键词：

卒中；下肢运动功能障碍；重复经颅磁刺激；Meta分析

Keywords：

Stroke; Lower-limb motor dysfunction; Repetitive transcranial magnetic stimulation; Meta-analysis

CLC：

R 743

DOI：

10.12114/j.issn.1008-5971.2022.00.213

Funds：

国家自然科学基金联合基金重点支持项目（U1613207）；广东医科大学青年培育基金（GDMUQ2021034）；康复医学四川省重点实验室2021年开放课题基金（KFYXSZDSYS-01）

摘要：

目的　系统评价重复经颅磁刺激（rTMS）治疗脑卒中后下肢运动功能障碍的疗效。方法　计算机检索中国知网、万方数据知识服务平台、PubMed、Embase、Web of Science、Cochrane Library上公开发表的rTMS治疗脑卒中后下肢运动功能障碍疗效的随机对照试验（RCT）。检索时限从建库至2021年12月。提取纳入文献的资料，采用Cochrane手册中的偏倚风险评估工具对纳入文献进行方法学质量评价，并运用RevMan 5.4进行Meta分析。结果　共纳入24篇文献，总样本量为1 286例。Meta分析结果显示，试验组Berg平衡量表（BBS）评分高于对照组〔均数差（MD ）=5.14，95%CI（3.60，6.68），P ＜0.000 1〕。根据rTMS刺激频率＞1 Hz或≤1 Hz分为高频rTMS和低频rTMS进行亚组分析，结果显示，采用高频rTMS或低频rTMS的试验组BBS评分均高于对照组〔MD =6.45，95%CI （5.42，7.48），P ＜0.000 01；MD =3.08，95%CI （1.99，4.17），P ＜0.000 01〕。试验组起立-行走计时测试（TUGT）＜120 s者所占比例高于对照组〔相对危险度（RR ）=1.98，95%CI （1.02，3.85），P =0.04〕，试验组三维步态分析步速快于对照组〔标准均数差（SMD ）=0.90，95%CI （0.65，1.15），P ＜0.000 01〕，试验组10 m步行计时测试（10 m MWT）最大步速快于对照组〔MD =12.17，95%CI （8.89，15.46），P ＜0.000 01〕，试验组Fugl-Meyer运动功能评价量表下肢部分（FMA-LE）评分高于对照组〔MD =2.95，95%CI （2.01，3.89），P ＜0.000 01〕。两组患侧下肢单支撑期占步行周期比值、患侧下肢摆动期占步行周期比值比较，差异无统计学意义〔SMD =0.42，95%CI （-0.10，0.93），P =0.11；SMD =0.36，95%CI （-0.39，1.10），P =0.35〕。结论　rTMS可以有效提升脑卒中后下肢运动功能障碍患者平衡能力和行走速度，改善患者下肢运动功能，但对改善步态对称性效果尚不明确，仍需大量高质量RCT进行探索。

Abstract：

Objective　To systematically evaluate the efficacy of repeatitive transcranial magnetic stimulation(rTMS) on lower-limb motor dysfunction after stroke. Methods　CNKI, Wanfang Data, PubMed, Embase, Web of Science,Cochrane Library were searched on online for randomized controlled trial (RCT) reporting the efficacy of rTMS on lowerlimbmotor dysfunction after stroke. The retrieval time was from the establishment of the database to December 2021. Thedata of the included literature was extracted, the bias risk assessment tool in Cochrane manual was used to evaluate thequality of the included literature, and RevMan 5.4 was used for meta-analysis. Results　A total of 24 articles were included,and involving 1 286 patients. The results of meta-analysis showed that, the Berg Balance Scale (BBS) score in the testgroup was higher than that in the control group [mean difference (MD ) =5.14, 95%CI (3.60, 6.68) , P < 0.000 1] . Subgroupanalysis was conducted according to different frequency stimulation of rTMS (> 1 Hz and ≤ 1 Hz) , the results showed thatthe BBS score in the experimental group using high frequency rTMS or low frequency rTMS was higher than that in thecontrol group, respectively [MD =6.45, 95%CI (5.42, 7.48) , P < 0.000 01; MD =3.08, 95%CI (1.99, 4.17) , P < 0.000 01] . Theproportion of TUGT < 120 s in the test group was higher than that in the control group [risk ratio (RR ) =1.98, 95%CI (1.02,3.85) , P =0.04] , step speed measured by 3D gait analysis in the test group was faster than that in the control group [standardmean difference (SMD ) =0.90, 95%CI (0.65, 1.15) , P < 0.000 01] , maximum step speed measured by 10 m maximum walktest (10 m MWT) in the test group was higher than that in the control group [MD =12.17, 95%CI (8.89, 15.46) , P < 0.000 01] ,Fugl-Meyer motor function assessment lower-extremity (FMA-LE) score in the test group was higher than that in thecontrol group [MD =2.95, 95%CI (2.01, 3.89) , P < 0.000 01] . There was no significant difference in the ratio of singlesupport phase to walking cycle of affected side lower limb and the ratio of swing phase to walking cycle of affectedside lower limb between the two groups [SMD =0.42, 95%CI (-0.10, 0.93) , P =0.11; SMD =0.36, 95%CI (-0.39, 1.10) ,P =0.35] . Conclusion　rTMS can improve balance function, walking speed and lower limb motor function in the patients withlower-limb motor dysfunction after stroke, however, the effect of improving gait symmetry is unclear, and we need a large numberof high-quality RCT to explore.

ReferenceList：