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三种类型经颅直流电刺激对脑卒中后失语症患者干预效果的网状Meta分析
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Abstract:
目的：系统评价阳极、阴极、双极三种经颅直流电刺激对脑卒中后失语症患者语言功能的影响，为临床制定刺激方案提供参考。方法：计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、CBM、知网、万方、维普数据库中关于经颅直流电刺激改善脑卒中后失语症患者语言功能恢复效果的随机对照试验。检索时限均从建库至2024年4月9日。由2名评价员独立筛选文献、提取内容并采用Cochrane随机对照试验偏倚风险评价工具对纳入的研究进行质量评价，分别采用RevMan 5.4及R语言gemtc包进行传统Meta分析和网状Meta分析，绘制网络关系图、联赛表和累积概率排序表。结果：① 共纳入20项研究，包括864例患者，其中文献质量A级8篇，B级19篇。② Meta分析显示，与对照组相比经颅直流电刺激可显著提高西方失语症成套测试(Western aphasia battery, WAB)中的自发言语评分(MD = 1.72, 95% CI: 1.28~2.15, P < 0.00001)、听理解评分(MD = 0.31, 95% CI: 0.31~0.48, P < 0.0004)、复述评分(MD = 1.70, 95% CI: 1.13~2.26, P < 0.0004)、命名评分(MD = 1.44, 95% CI: 0.99~1.89, P < 0.0001)、失语商评分(Aphasia quotient, AQ) (MD = 9.17, 95% CI: 6.32~12.02, P < 0.0001)。③ 网状Meta分析显示：在WAB-自发、听理解、复述、命名、AQ；图片命名项目方面，三种经颅直流电刺激方式的概率排序为：双极 > 阳极 > 阴极 > 对照。结论：经颅直流电刺激可显著改善脑卒中患者语言功能，其中双极刺激对改善患者语言功能的疗效更佳，受纳入研究数量和质量的限制，上述结论尚待更多高质量研究予以验证。
Objective: To systematically evaluate the effects of anodal, cathodal and bipolar transcranial direct current stimulation on language function in patients with post-stroke aphasia, and to provide a reference for clinical stimulation programs. Methods: The databases of PubMed, EMbase, The Cochrane Library, Web of Science, CBM, CNKI, Wanfang and VIP were searched for randomized controlled trials (RCTS) on the effect of transcranial direct current stimulation on language function recovery in patients with aphasia after stroke. The search time limit was from the establishment of the database to April 9, 2024. Two reviewers independently screened the literature, extracted the content, and evaluated the quality of the included studies using the Cochrane Risk of Bias assessment tool for randomized controlled trials. RevMan 5.4 and R language gemtc package were used for traditional meta-analysis and network meta-analysis, respectively, and the network diagram, league table and cumulative probability ranking table were drawn. Results: ① A total of 20 studies involving 864 patients were included, of which 8 were grade A and 19 were grade B. ② Meta-analysis showed that transcranial direct current stimulation significantly improved the spontaneous speech score in the Western aphasia battery (WAB) compared with the control group (MD = 1.72, 95% CI: 1.28~2.15, P < 0.00001), listening comprehension score (MD = 0.31, 95% CI: 0.31~0.48, P < 0.0004), repetition score (MD = 1.70, 95% CI: 1.13-2.26, P < 0.0004), naming score (MD = 1.44, 95% CI: 0.99~1.89, P <
| [1] | Brady, M.C., Kelly, H., Godwin, J., Enderby, P. and Campbell, P. (2016) Speech and Language Therapy for Aphasia Following Stroke. Cochrane Database of Systematic Reviews, 2016, CD000425. https://doi.org/10.1002/14651858.cd000425.pub4 |
| [2] | Flowers, H.L., Skoretz, S.A., Silver, F.L., Rochon, E., Fang, J., Flamand-Roze, C., et al. (2016) Poststroke Aphasia Frequency, Recovery, and Outcomes: A Systematic Review and Meta-Analysis. Archives of Physical Medicine and Rehabilitation, 97, 2188-2201.e8. https://doi.org/10.1016/j.apmr.2016.03.006 |
| [3] | Pedersen, P.M., Vinter, K. and Olsen, T.S. (2003) Aphasia after Stroke: Type, Severity and Prognosis. Cerebrovascular Diseases, 17, 35-43. https://doi.org/10.1159/000073896 |
| [4] | Villa, R.F., Ferrari, F. and Moretti, A. (2018) Post-Stroke Depression: Mechanisms and Pharmacological Treatment. Pharmacology & Therapeutics, 184, 131-144. https://doi.org/10.1016/j.pharmthera.2017.11.005 |
| [5] | Monnelly, K., Marshall, J., Dipper, L. and Cruice, M. (2023) Intensive and Comprehensive Aphasia Therapy—A Survey of the Definitions, Practices and Views of Speech and Language Therapists in the United Kingdom. International Journal of Language & Communication Disorders, 58, 2077-2102. https://doi.org/10.1111/1460-6984.12918 |
| [6] | Raymer, A.M. and Johnson, R.K. (2024) Effectiveness of Transcranial Direct Current Stimulation as an Adjuvant to Aphasia Treatment Following Stroke: Evidence from Systematic Reviews and Meta-Analyses. American Journal of Speech-Language Pathology, 2, 1-13. |
| [7] | Bucur, M. and Papagno, C. (2018) A Systematic Review of Noninvasive Brain Stimulation for Post-Stroke Depression. Journal of Affective Disorders, 238, 69-78. https://doi.org/10.1016/j.jad.2018.05.026 |
| [8] | Meier, E.L., Kapse, K.J. and Kiran, S. (2016) The Relationship between Frontotemporal Effective Connectivity during Picture Naming, Behavior, and Preserved Cortical Tissue in Chronic Aphasia. Frontiers in Human Neuroscience, 10, Article No. 109. https://doi.org/10.3389/fnhum.2016.00109 |
| [9] | 崔莹, 黎波, 田光. 经颅直流电刺激治疗脑卒中后失语症临床疗效Meta分析[J]. 康复学报, 2022, 32(6): 553-561. |
| [10] | Han, C., Tang, J., Tang, B., Han, T., Pan, J. and Wang, N. (2024) The Effectiveness and Safety of Noninvasive Brain Stimulation Technology Combined with Speech Training on Aphasia after Stroke: A Systematic Review and Meta-analysis. Medicine, 103, e36880. https://doi.org/10.1097/md.0000000000036880 |
| [11] | Cherney, L.R., Babbitt, E.M., Wang, X. and Pitts, L.L. (2021) Extended fMRI-Guided Anodal and Cathodal Transcranial Direct Current Stimulation Targeting Perilesional Areas in Post-Stroke Aphasia: A Pilot Randomized Clinical Trial. Brain Sciences, 11, Article No. 306. https://doi.org/10.3390/brainsci11030306 |
| [12] | Zhao, Q., Wang, J., Li, Z., Song, L. and Li, X. (2021) Effect of Anodic Transcranial Direct Current Stimulation Combined with Speech Language Therapy on Nonfluent Poststroke Aphasia. Neuromodulation: Technology at the Neural Interface, 24, 923-929. https://doi.org/10.1111/ner.13337 |
| [13] | Zumbansen, A., Black, S.E., Chen, J.L., J Edwards, D., Hartmann, A., Heiss, W., et al. (2020) Non-Invasive Brain Stimulation as Add-On Therapy for Subacute Post-Stroke Aphasia: A Randomized Trial (Northstar). European Stroke Journal, 5, 402-413. https://doi.org/10.1177/2396987320934935 |
| [14] | Polanowska, K.E., Leśniak, M., Seniów, J.B. and Członkowska, A. (2013) No Effects of Anodal Transcranial Direct Stimulation on Language Abilities in Early Rehabilitation of Post-Stroke Aphasic Patients. Neurologia i Neurochirurgia Polska, 47, 414-422. https://doi.org/10.5114/ninp.2013.38221 |
| [15] | Feil, S., Eisenhut, P., Strakeljahn, F., Müller, S., Nauer, C., Bansi, J., et al. (2019) Left Shifting of Language Related Activity Induced by Bihemispheric tDCS in Postacute Aphasia Following Stroke. Frontiers in Neuroscience, 13, Article No. 295. https://doi.org/10.3389/fnins.2019.00295 |
| [16] | Spielmann, K., van de Sandt-Koenderman, W.M.E., Heijenbrok-Kal, M.H. and Ribbers, G.M. (2018) Transcranial Direct Current Stimulation Does Not Improve Language Outcome in Subacute Poststroke Aphasia. Stroke, 49, 1018-1020. https://doi.org/10.1161/strokeaha.117.020197 |
| [17] | Meinzer, M., Darkow, R., Lindenberg, R. and Flöel, A. (2016) Electrical Stimulation of the Motor Cortex Enhances Treatment Outcome in Post-Stroke Aphasia. Brain, 139, 1152-1163. https://doi.org/10.1093/brain/aww002 |
| [18] | 房辉, 高芳兰, 任彩丽, 等. 双额叶在线经颅直流电刺激联合强制诱导性语言疗法在卒中后亚急性期失语症患者中的应用效果[J]. 实用心脑肺血管病杂志, 2022, 30(6): 110-114. |
| [19] | 路慧聪. 左侧颞上回后部经颅直流电刺激对脑卒中后失语症口语理解及表达的影响[D]: [硕士学位论文]. 广州: 广州医科大学, 2021. |
| [20] | 张莉, 沈莉. 经颅直流电刺激联合记忆强化训练治疗缺血性脑卒中后失语症患者的临床效果[J]. 实用心脑肺血管病杂志, 2020, 28(1): 112-115. |
| [21] | 陶媛媛, 孙蓉, 乐捷, 等. 经颅直流电刺激对卒中后失语患者视听觉通道命名的效果[J]. 中国康复理论与实践, 2019, 25(5): 506-512. |
| [22] | 张洪, 刘静, 杨未风, 等. 经颅直流电刺激联合常规言语康复治疗脑卒中后非流畅性失语症的疗效观察[J]. 康复学报, 2017, 27(3): 39-42, 46. |
| [23] | 张茜, 代欣, 贺媛, 等. 经颅直流电刺激联合言语训练对脑梗死后失语症的治疗效果[J]. 蚌埠医学院学报, 2020, 45(5): 601-605. |
| [24] | 夏思颖, 章丽雅, 叶靓, 等. 经颅直流电刺激联合计算机辅助综合训练对脑梗死后非流畅性失语症患者语言功能的改善效果[J]. 中国现代医生, 2022, 60(10): 111-114. |
| [25] | 张芹, 江钟立, 方欣, 等. 词联导航训练法联合经颅直流电刺激改善失语症言语流畅度及命名能力的临床观察[J]. 中国康复医学杂志, 2017, 32(8): 879-884. |
| [26] | 钟红丽, 蔡琛, 杜振峰. 语言认知功能训练联合经颅直流电刺激治疗脑卒中失语症患者疗效观察[J]. 内科, 2021, 16(3): 317-319. |
| [27] | 张雅妮. 经颅直流电刺激作用于左外侧裂后部对失语症听理解、阅读理解的作用[D]: [硕士学位论文]. 太原: 山西医科大学, 2018. |
| [28] | 刘晓蔚, 王强, 柏广涛, 等. 健侧半球经颅直流电刺激对亚急性期非流利性卒中后失语患者的治疗效果[J]. 精准医学杂志, 2023, 38(3): 245-248+253. |
| [29] | 周涛, 郭壮丽, 梁颖. 经颅直流电刺激联合常规言语训练治疗卒中后失语症患者的疗效观察[J]. 临床医学进展, 2023, 13(11): 17772-17779. |
| [30] | 王玲, 张银, 李悦, 等. 非侵入式经颅直流电刺激对脑卒中后失语症的临床效果研究[J]. 四川大学学报(医学版), 2018, 49(5): 815-816. |
| [31] | Boehme, A.K., Martin-Schild, S., Marshall, R.S. and Lazar, R.M. (2016) Effect of Aphasia on Acute Stroke Outcomes. Neurology, 87, 2348-2354. https://doi.org/10.1212/wnl.0000000000003297 |
| [32] | Ellis, C., Simpson, A.N., Bonilha, H., Mauldin, P.D. and Simpson, K.N. (2012) The One-Year Attributable Cost of Poststroke Aphasia. Stroke, 43, 1429-1431. https://doi.org/10.1161/strokeaha.111.647339 |
| [33] | Ali, M., Lyden, P. and Brady, M. (2013) Aphasia and Dysarthria in Acute Stroke: Recovery and Functional Outcome. International Journal of Stroke, 10, 400-406. https://doi.org/10.1111/ijs.12067 |
| [34] | 蔡缘邯, 郝利霞, 张琰, 等. 经颅直流电刺激对脑血流影响的研究进展[J]. 中国康复医学杂志, 2022, 37(6): 840-844. |
| [35] | Chhatbar, P.Y., Ramakrishnan, V., Kautz, S., George, M.S., Adams, R.J. and Feng, W. (2016) Transcranial Direct Current Stimulation Post-Stroke Upper Extremity Motor Recovery Studies Exhibit a Dose-Response Relationship. Brain Stimulation, 9, 16-26. https://doi.org/10.1016/j.brs.2015.09.002 |
| [36] | 马晓婷, 王凯凯, 祖合热·肉孜, 等. 经颅直流电刺激在卒中后失语症治疗中的应用研究进展[J]. 中国康复, 2022, 37(2): 117-121. |
| [37] | 刘蒙蒙, 徐桂芝, 于洪丽, 等. 经颅直流电刺激下脑卒中患者康复期脑功能网络特性研究[J]. 生物医学工程学杂志, 2021, 38(3): 498-506+511. |
| [38] | Friederici, A.D. and Alter, K. (2004) Lateralization of Auditory Language Functions: A Dynamic Dual Pathway Model. Brain and Language, 89, 267-276. https://doi.org/10.1016/s0093-934x(03)00351-1 |
| [39] | 朱苏琼, 顾介鑫. 经颅直流电刺激在失语症康复中的应用研究进展[J]. 中国康复理论与实践, 2018, 24(1): 84-89. |
| [40] | Lee, S.Y., Cheon, H., Yoon, K.J., Chang, W.H. and Kim, Y. (2013) Effects of Dual Transcranial Direct Current Stimulation for Aphasia in Chronic Stroke Patients. Annals of Rehabilitation Medicine, 37, 603-610. https://doi.org/10.5535/arm.2013.37.5.603 |
| [41] | Fiori, V., Nitsche, M., Iasevoli, L., Cucuzza, G., Caltagirone, C. and Marangolo, P. (2017) Differential Effects of Bihemispheric and Unihemispheric Transcranial Direct Current Stimulation in Young and Elderly Adults in Verbal Learning. Behavioural Brain Research, 321, 170-175. https://doi.org/10.1016/j.bbr.2016.12.044 |
| [42] | Biou, E., Cassoudesalle, H., Cogné, M., Sibon, I., De Gabory, I., Dehail, P., et al. (2019) Transcranial Direct Current Stimulation in Post-Stroke Aphasia Rehabilitation: A Systematic Review. Annals of Physical and Rehabilitation Medicine, 62, 104-121. https://doi.org/10.1016/j.rehab.2019.01.003 |
| [43] | Giovannella, M., Mitjà, G., Gregori-Pla, C., Kacprzak, M., Ibañez, D., Ruffini, G., et al. (2017) Concurrent Diffuse Optical Measurement of Cerebral Hemodynamics and EEG during Transcranial Direct Current Stimulation (tDCS) in Humans. Brain Stimulation, 10, Article No. 383. https://doi.org/10.1016/j.brs.2017.01.132 |
| [44] | Stagg, C.J., Bachtiar, V. and Johansen-Berg, H. (2011) The Role of GABA in Human Motor Learning. Current Biology, 21, 480-484. https://doi.org/10.1016/j.cub.2011.01.069 |
| [45] | Yamada, Y. and Sumiyoshi, T. (2021) Neurobiological Mechanisms of Transcranial Direct Current Stimulation for Psychiatric Disorders; Neurophysiological, Chemical, and Anatomical Considerations. Frontiers in Human Neuroscience, 15, Article ID: 631838. https://doi.org/10.3389/fnhum.2021.631838 |
| [46] | Zheng, X., Alsop, D.C. and Schlaug, G. (2011) Effects of Transcranial Direct Current Stimulation (tDCS) on Human Regional Cerebral Blood Flow. NeuroImage, 58, 26-33. https://doi.org/10.1016/j.neuroimage.2011.06.018 |
| [47] | Abbott, N.T., Baker, C.J., Chen, C., Liu, T.T. and Love, T.E. (2021) Defining Hypoperfusion in Chronic Aphasia: An Individualized Thresholding Approach. Brain Sciences, 11, Article No. 491. https://doi.org/10.3390/brainsci11040491 |
| [48] | Nicolo, P., Magnin, C., Pedrazzini, E., Plomp, G., Mottaz, A., Schnider, A., et al. (2018) Comparison of Neuroplastic Responses to Cathodal Transcranial Direct Current Stimulation and Continuous Theta Burst Stimulation in Subacute Stroke. Archives of Physical Medicine and Rehabilitation, 99, 862-872.e1. https://doi.org/10.1016/j.apmr.2017.10.026 |
| [49] | Mondini, V., Mangia, A.L. and Cappello, A. (2018) Single-Session tDCS over the Dominant Hemisphere Affects Contralateral Spectral EEG Power, but Does Not Enhance Neurofeedback-Guided Event-Related Desynchronization of the Non-Dominant Hemisphere’s Sensorimotor Rhythm. PLOS ONE, 13, e0193004. https://doi.org/10.1371/journal.pone.0193004 |
