药物联合rTMS对帕金森病临床症状及血清学指标改善的Meta分析

Meta Analysis of Drug Combination with rTMS for Improving Clinical Symptoms and Serological Indicators of Parkinson’s Disease

摘要: 目的：针对药物联合rTMS治疗帕金森病的临床疗效进行文献Meta分析，为优化帕金森病治疗方案提供数据支持。方法：检索英文及中文数据库，收集rTMS联合药物治疗PD临床效果的相关文献，采集核心数据，进行Meta分析。结果：与单纯普拉克索组相比，rTMS联合普拉克索治疗PD后患者精神行为情绪[WMD = −0.37, 95% CI = (−0.47, −0.26)]，日常生活活动能力[WMD = −1.43, 95% CI = (−2.15, −0.70)]，运动功能[WMD = −2.13, 95% CI = (−2.74, −1.51)]，抑郁评分[WMD = −2.31, 95% CI = (−2.84, −1.78)]，简易智能精神状态[WMD = 2.23, 95%CI = (1.91, 2.54)]均得到改善，且两组间存在统计学差异(p < 0.05)。氧化应激反应指标均降低，Cys-C [WMD = −0.25, 95% CI = (−0.31, −0.19)]、NES [WMD = −2.75, 95% CI = (−3.50, −2.00)]、S100B [WMD = −4.88, 95% CI = (−6.03, −3.74)]，两组间存在统计学意义(p < 0.05)。与单纯多巴丝肼组相比，rTMS联合多巴丝肼治疗PD后患者精神行为情绪[WMD = −2.13, 95% CI = (−2.99, −1.27)]，日常生活活动能力[WMD = −6.11, 95% CI = (−7.05, −5.16)]，运动功能[WMD = −4.87, 95%CI = (−6.05, −3.69)]，自主神经症状[WMD = −6.85, 95% CI = (−7.96, −5.74)]均得到改善，且两组间存在统计学差异(p < 0.05)。神经递质水平得到改善，乙酰胆碱[WMD = −2.74, 95% CI = (−4.05, −1.44)]、多巴胺[WMD = 13.81, 95% CI = (11.02, 16.61)]，两组间存在统计学意义(p < 0.05)。结论：rTMS联合药物治疗可有效改善PD患者临床疗效，并对血清氧化应激及神经递质水平也存在调整作用。

Abstract: Objective: To conduct a literature Meta-analysis on the clinical efficacy of drug combined with rTMS in the treatment of Parkinson’s disease, providing data support for optimizing the treatment plan of Parkinson’s disease. Method: Retrieve English and Chinese databases, collect relevant literature on the clinical efficacy of rTMS combined with drug therapy for PD, collect core data, and conduct Meta-analysis. Result: Compared with the Pramipexole alone group, patients with Parkinson’s disease treated with the combination of rTMS and Pramipexole had psychology, behavior and emotional [WMD = −0.37, 95% CI = (−0.47, −0.26)], activities of daily living [WMD = −1.43, 95% CI = (−2.15, −0.70)], motor function [WMD = −2.13, 95% CI = (−2.74, −1.51)], depression score [WMD = −2.31, 95% CI = (−2.84, −1.78)], and simplified mental state [WMD = 2.23, 95% CI = (1.91, 2.54)] showed varying degress of improvement, and there was a statistical difference between the two groups (p < 0.05). The oxidative stress response indicators were all reduced, with Cys-C [WMD = −0.25, 95% CI = (−0.31, −0.19)], NES [WMD = −2.75, 95% CI = (−3.50, −2.00)], S100B [WMD = −4.88, 95% CI = (−6.03, −3.74)] showing statistical significance between the two groups (p < 0.05). Compared with the group treated with levodopa and benserazide hydrochloride alone, patients with prkinson’s disease treated with the combination of rTMS and levodopa and benserazide hydrochloride showed varying degrees of improvement in their psychology, behavior and emotional [WMD = −2.13, 95% CI = (−2.99, −1.27)], activities of daily living [WMD = −6.11, 95% CI = (−7.05, −5.16)], motor function [WMD = −4.87, 95% CI = (−6.05, −3.69)], and autonomic nervous system symptoms [WMD = −6.85, 95% CI = (−7.96, −5.74)], and there was a statistically significant difference between the two groups (p < 0.05). The levels of neurotransmitters were improved, with acetylcholine [WMD = −2.74, 95% CI = (−4.05, −1.44)] and dopamine [WMD = 13.81, 95% CI = (11.02, 16.61)] showing statistical significance between the two groups (p < 0.05). Conclusion: rTMS combined with drug therapy can effectively improve the clinical efficacy of PD patients and also have an adjusting effect on serum oxidative stress and neurotransmitter levels.