上海交通大学学报（医学版）

上海交通大学学报(医学版) ›› 2021, Vol. 41 ›› Issue (7): 931-941.doi: 10.3969/j.issn.1674-8115.2021.07.014

• 论著 · 循证医学 • 上一篇    

经颅磁刺激对阿尔茨海默病患者认知功能及伴痴呆的行为精神症状疗效的meta分析

王毅1(), 程诚1, 沈红艳1, 高红艳1, 戴悦宁2, 易正辉3()   

  1. 1.上海市嘉定区精神卫生中心精神科，上海 201806
    2.上海中医药大学岳阳临床医学院中西医临床医学，上海 201203
    3.上海交通大学医学院附属精神卫生中心精神科，上海 200030
  • 出版日期:2021-07-28 发布日期:2021-08-03
  • 通讯作者: 易正辉 E-mail:wang19831027@126.com;yizhenghui1971@163.com
  • 作者简介:王毅（1983—），男，主治医师，学士；电子信箱：wang19831027@126.com。
  • 基金资助:
    上海市嘉定区卫生健康委员会第五批医学重点学科建设精神病学方向(2020-jdyxzdxk-17);上海市嘉定区卫生和计划生育委员会科研课题(2019-KY-22)

Meta-analysis of efficacy of transcranial magnetic stimulation for the treatment of cognitive function and behavioral and psychological symptoms of dementia in patients with Alzheimer′s disease

Yi WANG1(), Cheng CHENG1, Hong-yan SHEN1, Hong-yan GAO1, Yue-ning DAI2, Zheng-hui YI3()   

  1. 1.Department of Psychiatry, Jiading Mental Health Center, Shanghai 201806, China
    2.Clinical Medicine of Traditional Chinese and Western Medicine, Yueyang Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
    3.Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
  • Online:2021-07-28 Published:2021-08-03
  • Contact: Zheng-hui YI E-mail:wang19831027@126.com;yizhenghui1971@163.com

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摘要：

目的·系统评价经颅磁刺激（transcranial magnetic stimulation，TMS）对阿尔茨海默病（Alzheimer′s disease，AD）患者认知功能及伴痴呆的行为精神症状（behavioral and psychological symptoms of dementia，BPSD）的疗效。方法·检索2019年11月2日以前的中国知网、万方、维普、中国生物医学文献数据库、PubMed、Embase、The Cochrane Library及中国和美国临床试验注册中心等9个数据库的所有文献。英文以“Alzheimer′s disease”“transcranial magnetic stimulation”和“randomize controlled trial”为主题词进行检索，并检索自由词；中文以“阿尔茨海默病”“经颅磁刺激”“随机对照试验”为主题词进行检索。按照预先制定的纳入和排除标准，筛选文献。使用RevMan 5.3软件，以标准化均数差（standardized mean difference，SMD）为效应值，区间估计使用95%置信区间（confidence interval，CI）进行统计分析；应用GradeProfile 3.2.2软件进行证据质量等级评价。结果·共纳入23篇文献。在改善认知功能方面：阿尔茨海默病疾病评估量表-认知子量表评价结果提示，高频TMS组效应值SMD=-0.64（95%CI -0.89~-0.40，P=0.000），低频组效应值SMD=-0.58（95%CI -1.12~-0.05，P=0.030）；Grade证据质量等级显示，高频组为极低质量，低频组为低质量。使用简易智力状态检查量表评价认知功能时，根据TMS频率的高低、数值及治疗的次数分为3个亚组进行，结果提示，高频TMS组效应量SMD=1.30（95%CI 0.76~1.85，P=0.000），低频组疗效无统计学意义，Grade证据质量等级显示高频组和低频组均为极低质量；5 Hz组效应量SMD=3.99（95%CI 0.81~7.16，P=0.010），Grade证据质量等级为极低质量；治疗次数>40次且≤60次组效应量SMD=3.28（95%CI 1.67~4.90，P=0.000），Grade证据质量等级为极低质量。在改善BPSD方面：使用神经精神量表评价，结果无统计学意义，Grade证据质量等级为极低质量。使用AD病理行为症状量表评价分析显示，高频组效应量SMD=-0.83（95%CI -1.06~-0.60，P=0.000），低频TMS疗效无统计学意义；Grade证据质量等级显示，高频组结果为低质量，低频组结果为极低质量。结论·TMS能够改善AD患者的认知功能，且高频要优于低频，证据质量等级较低；而对AD患者的BPSD是否有效尚需进一步的研究。未来应纳入更多高质量的临床多中心随机对照研究来评价TMS对AD的疗效和安全性，为临床实践提供指导。

关键词: 阿尔茨海默病, 经颅磁刺激, 认知功能, 伴痴呆的行为精神症状, meta分析, 随机对照试验

Abstract:

Objective·To evaluate the efficacy of transcranial magnetic stimulation (TMS) on cognitive function and behavioral and psychological of dementia (BPSD) in Alzheimer′s disease (AD) patients.

Methods·Nine databases including China National Knowledge Infrastructure (CNKI), WanFang, VIP, Chinese Biomedical Literature Database (CBM), PubMed, Embase, the Cochrane Library and Chinese and American Clinical Trial Center were searched before November 2, 2019. English was searched with the topics of “Alzheimer′s disease” “transcranial magnetic stimulation” and “randomize controlled trial”, and free words were retrieved. Chinese was searched with the topics of “阿尔茨海默病”“经颅磁刺激”“随机对照试验”. According to the pre-established inclusion and exclusion criteria, the literatures were screened. RevMan 5.3 software was used. The standardized mean difference (SMD) was used as the effect value, and 95% confidence interval (CI) was used for interval estimation. Gradeprofile 3.2.2 software was used to evaluate the quality of evidence.

Results·A total of 23 articles were included. In improving cognitive function, the evaluation results of AD Assessment Scale-Cognitive suggest that SMD of high frequency TMS group was -0.64 (95%CI -0.89 ? -0.40, P=0.000), SMD of low frequency TMS group was -0.58 (95%CI -1.12 ? -0.05, P=0.030). The Grade of evidence quality was very lower and lower respectively. When using Mini-Mental State Examination to evaluate cognitive function, it was divided into three subgroups according to TMS frequency (high or low, value) and treatment times. The results showed that SMD in high frequency TMS group was 1.30 (95% CI 0.76?1.85, P = 0.000), but no significant difference was found in low frequency group. The Grade of evidence quality were both very lower. In 5 Hz group, SMD was 3.99 (95%CI 0.81~7.16, P=0.010) and the Grade evidence quality grade was very low. In the group of treatment times >40 and ≤60, SMD was 3.28 (95%CI 1.67?4.90, P=0.000) and the Grade evidence quality grade was very low. In the aspect of improving BPSD, the Neuropsychiatric Inventory was used to evaluate, and the result was no statistically significant. The Grade evidence quality grade was very low. Behavioral Pathology in Alzheimer′s Disease Scale showed that SMD of high frequency group was -0.83 (95%CI -1.06? -0.60, P=0.000), and there was no significance in low frequency group.The Grade evidence quality grade were low and very low respectively.

Conclusion·TMS could improve the cognitive function of patients with AD, and high frequency was better than low frequency. The quality of evidence was lower. Whether the BPSD of AD patients were effective needs further research. In the future, more high-quality clinical multicenter randomized controlled trails should be included to study the efficacy and safety of TMS in the treatment of AD, so as to provide guidance for clinical practice.

Key words: Alzheimer′s disease (AD), transcranial magnetic stimulation (TMS), cognitive function, behavioral and psychological symptoms of dementia (BPSD), meta-analysis, randomized controlled trial (RCT)

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