摘要
目的:采用网状Meta分析系统评价不同非侵入性神经调控技术对孤独症谱系障碍儿童的康复疗效。方法:系统检索中国知网、维普网、万方数据知识服务平台、中国生物医学文献数据库、Pub Med、Web of Science、Cochrane Library、Embase数据库,选择不同非侵入性神经调控技术改善孤独症谱系障碍的随机对照试验,检索时限为各数据库建库至2025年1月,由2名研究者独立进行文献筛选、数据提取并对纳入的研究进行质量评价,应用Stata 18.0软件对数据进行网状Meta分析。结果:共纳入32个随机对照试验,涉及8种干预方式。网状Meta分析结果显示,在常规康复训练的基础上,在改善孤独症行为量表评分方面,虚拟现实技术效果最佳[SMD=-12.55,95%CI(-20.85,-4.25),P<0.05],其次为θ爆发式磁刺激[SMD=-11.34,95%CI(-20.94,-1.74),P<0.05]、重复经颅磁刺激[SMD=-9.28,95%CI(-12.80,-5.77),P<0.05]、神经反馈技术[SMD=-8.75,95%CI(-15.26,-2.23),P<0.05];在儿童孤独症评定量表评分方面,虚拟现实技术改善效果最为显著[SMD=-6.36,95%CI(-9.61,-3.11),P<0.05],其次为重复经颅磁刺激[SMD=-5.98,95%CI(-9.46,-2.51),P<0.05]、神经反馈技术[SMD=-4.63,95%CI(-9.14,-0.13),P<0.05]、经皮神经电刺激[SMD=-4.14,95%CI(-5.73,-2.55),P<0.05];在孤独症治疗评估量表评分方面,神经反馈技术改善效果最显著[SMD=-16.44,95%CI(-24.10,-8.78),P<0.05],其次为虚拟现实技术[SMD=-14.09,95%CI(-22.45,-5.73),P<0.05]、重复经颅磁刺激[SMD=-12.06,95%CI(-16.45,-7.68),P<0.05]、经皮神经电刺激[SMD=-10.58,95%CI(-20.44,-0.72),P<0.05]、经颅直流电刺激[SMD=-9.75,95%CI(-18.62,-0.88),P<0.05]。结论:当前证据表明,在常规康复训练基础上,不同非侵入性神经调控技术对孤独症谱系障碍的改善效果存在差异。虚拟现实技术在改善孤独症行为量表和儿童孤独症评定量表评分方面表现出最佳效果,而神经反馈技术在孤独症治疗评估量表评分方面的改善效果最为显著。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 rehabilitation efficacy of different non-invasive neuromodulation techniques in children with autism spectrum disorder by network meta-analysis.METHODS:A literature search was conducted in CNKI,VIP,WanFang,China Biomedical Literature Database,PubMed,Web of Science,Cochrane Library,and Embase for randomized controlled trials of different non-invasive neuromodulation techniques to improve autism spectrum disorders.The search time was from database inception to January 2025,and two reviewers independently screened the literature,extracted the data,and evaluated the quality of the included studies,and used Stata 18.0 to perform a network meta-analysis of the data.RESULTS:A total of 32 randomized controlled trials involving 8 intervention modalities were included.The results of network meta-analysis showed that based on the application of conventional rehabilitation training,virtual reality technology had the best effect in improving the score of the Autism Behavior Scale[standardized mean difference(SMD)=-12.55,95%confidence interval(CI)(-20.85,-4.25),P<0.05],followed by Theta burst magnetic stimulation[SMD=-11.34,95%CI(-20.94,-1.74),P<0.05],repetitive transcranial magnetic stimulation[SMD=-9.28,95%CI(-12.80,-5.77),P<0.05],and neurofeedback technology[SMD=-8.75,95%CI(-15.26,-2.23),P<0.05].In terms of the Childhood Autism Rating Scale score,virtual reality technology had the most significant improvement effect[SMD=-6.36,95%CI(-9.61,-3.11),P<0.05],followed by repetitive transcranial magnetic stimulation[SMD=-5.98,95%CI(-9.46,-2.51),P<0.05],neurofeedback technology[SMD=-4.63,95%CI(-9.14,-0.13),P<0.05],and transcutaneous electrical nerve stimulation[SMD=-4.14,95%CI(-5.73,-2.55),P<0.05].In terms of Autism Treatment Assessment Scale score,neurofeedback technology had the most significant improvement effect[SMD=-16.44,95%CI(-24.10,-8.78),P<0.05],followed by virtual reality technology[SMD=-14.09,95%CI(-22.45,-5.73),P<0.05],repetitive transcranial magnetic stimulation[SMD=-12.06,95%CI(-16.45,-7.68),P<0.05],transcutaneous electrical nerve stimulation[SMD=-10.58,95%CI(-20.44,-0.72),P<0.05],and transcranial direct current stimulation[SMD=-9.75,95%CI(-18.62,-0.88),P<0.05].CONCLUSION:The current evidence suggests that different non-invasive neuromodulation techniques have different effects on the improvement of autism spectrum disorder on the basis of conventional rehabilitation training.Virtual reality shows the best effect in improving Autism Behavior Scale and Child Autism Rating Scale scores,while neurofeedback technology shows the most significant improvement in Autism Treatment Assessment Scale scores.Due to the limitations of the number and quality of included studies,these conclusions need to be validated by more high-quality studies.
作者
高世爱
于子夫
陈金慧
曹新燕
冷晓轩
刘西花
Gao Shiai;Yu Zifu;Chen Jinhui;Cao Xinyan;Leng Xiaoxuan;Liu Xihua(School of Rehabilitation Medicine,Shandong University of Traditional Chinese Medicine,Jinan 250355,Shandong Province,China;Shandong Center for Disease Control and Prevention,Jinan 250014,Shandong Province,China;Department of Rehabilitation,Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250014,Shandong Province,China)
出处
《中国组织工程研究》
北大核心
2026年第10期2550-2559,共10页
Chinese Journal of Tissue Engineering Research
基金
国家自然科学基金青年基金项目(81802239),项目负责人:刘西花
山东省中医药科技项目(M-2023142),项目负责人:刘西花
山东省医务职工科技创新计划项目(SDYWZGKCJH2022024),项目负责人:刘西花。
关键词
孤独症谱系障碍
非侵入性神经调控技术
虚拟现实技术
网状Meta分析
随机对照试验
autism spectrum disorder
non-invasive neuromodulation techniques
virtual reality technology
network meta-analysis
randomized controlled trials
作者简介
第一作者:高世爱,女,2001年生,山东中医药大学在读硕士,主要从事神经与心肺疾病康复基础与临床研究。https://orcid.org/0009-0006-2294-061X;通讯作者:刘西花,博士,副主任医师,硕士生导师,山东中医药大学附属医院康复科,山东省济南市250014。
