摘要： 目的 评价重复经颅磁刺激治疗帕金森病的临床效果。方法 以经颅磁刺激（transcranial magnetic stimulation or TMS）、帕金森病（Parkinson's disease or PD）、随机对照试验（randomized controlled trial）为中英文检索词分别检索美国国立医学图书馆、荷兰医学文摘、Ovid MEDLINE、维普中文科技期刊数据库、万方数据库、中国知识基础设施工程等国内外知名数据库1999-2013 年发表的有关经颅磁刺激治疗帕金森病的文献，最终共计纳入16 篇，中文4 篇、英文12 篇，根据高频（> 1 Hz）和低频（≤ 1 Hz）磁刺激分别进行Meta 分析。结果 16 篇文献共纳入455 例帕金森病患者，试验组（经颅磁刺激组）236 例、对照组219 例。经高频和低频磁刺激治疗后，两组患者统一帕金森病评价量表（UPDRS）总评分差异具有统计学意义（WMD = -5.010，95%CI：-7.370 ~ -2.650，P = 0.000；WMD = -6.140，95%CI：-8.750 ~ -3.530，P = 0.000）。经高频磁刺激治疗后，两组患者UPDRSⅢ 评分（WMD = -4.380，95%CI：-8.260 ~ -0.500；P = 0.003），日常生活活动能力量表评分（WMD = -3.740，95%CI：-.660 ~ -2.820；P = 0.000）差异有统计学意义，而简易智能状态检查量表评分差异无统计学意义（WMD = 0.260，95%CI：-0.660 ~ 1.180；P = 0.580）。经低频磁刺激治疗后，两组患者UPDRSⅢ评分差异无统计学意义（WMD = -2.160，95%CI：-5.010 ~ 0.690；P = 0.370）。结论 重复经颅磁刺激可以改善帕金森病患者部分临床症状，提高生活质量，但未发现其对精神症状有效。

关键词: 帕金森病, 经颅磁刺激, Meta分析

Abstract: Objective  To investigate the clinical effect of repetitive transcranial magnetic stimulation (rTMS) therapy on Parkinson's disease (PD) using Meta-analysis. Methods Taking transcranial magnetic stimulation or TMS, Parkinson's disease or PD and randomized controlled trial as retrival words, search related articles during 1999 to 2013 from databases such as PubMed, EMBASE, Ovid MEDLINE, VIP, Wanfang and China National Knowledge Intrastructure (CNKI). Finally 16 articles (4 in Chinese and 12 in English) were included for Meta-analysis according to high-frequency stimulation (HFS > 1 Hz) and low-frequency stimulation (LFS ≤ 1 Hz) respectively.  Results  A total pf 455 PD patients were enrolled and divided into TMS group (N = 236) and control group (N = 219). After HFS and LFS therapies, the Unified Parkinson's Disease Rating Scale (UPDRS) score in TMS group was significantly different from control group (WMD = -5.010, 95%CI: -7.370— -2.650, P = 0.000; WMD = -6.140, 95%CI: -8.750— -3.530, P = 0.000). After HFS therapy, the UPDRS Ⅲ motor (WMD = -4.380, 95%CI: -8.260— -0.500; P = 0.003) and activities of daily living (ADL) scores (WMD = -3.740, 95%CI: -4.660— -2.820; P = 0.000) in TMS group were significantly different from that in control group. There were no significant differences in UPDRS Ⅲ motor score with LFS therapy (WMD = -2.160, 95%CI: -5.010— -0.690; P = 0.370) and the Mini-Mental State Examination (MMSE) score with HFS therapy between 2 groups (WMD = 0.260, 95%CI: -0.660—1.180; P = 0.580).  Conclusions  Repetitive transcranial magnetic stimulation therapy can ameliorate partial symptoms of Parkinson's disease for enhancing the quality of life, however, the improvement for mental disability was not found.

Key words: Parkinson disease, Transcranial magnetic stimulation, Meta-analysis