经颅直流电刺激对局灶性缺血性脑卒中啮齿动物模型的神经保护作用:一项荟萃分析。

Neuroprotection by Transcranial Direct Current Stimulation in Rodent Models of Focal Ischemic Stroke: A Meta-Analysis.

作者信息

Huang Jiapeng, Zhao Kehong, Zhao Ziqi, Qu Yun

机构信息

Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.

Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China.

出版信息

Front Neurosci. 2021 Nov 23;15:761971. doi: 10.3389/fnins.2021.761971. eCollection 2021.

Abstract

Infarct size is associated with stroke severity in clinical studies, so reducing it has become an important target and research hotspot in the treatment of ischemic stroke. Some preclinical studies have shown transcranial direct current stimulation (tDCS) reduced infarct size and improved neurological deficit, but others have not found beneficial effects. Besides, the optimal pattern of tDCS for ischemic stroke remains largely unknown. To shed light on the current circumstance and future research directions, the systematic review evaluated the effect of different tDCS paradigms in reducing infarct size and improving neurological deficit in rodent models of ischemic stroke and assessed the methodological quality of current literature. We searched the MEDLINE ( PubMed), EMBASE, Web of Science, and Scopus from their inception to August 18, 2021, to identify studies evaluating the effects of tDCS in rodent models of ischemic stroke. Eight studies were included, of which seven studies were included in the meta-analysis. The results showed cathodal tDCS, rather than anodal tDCS, reduced infarct size mainly measured by tetrazolium chloride and magnetic resonance imaging (standardized mean difference: -1.13; 95% CI: -1.72, -0.53; = 0.0002) and improved neurological deficit assessed by a modified neurological severity score (standardized mean difference: -2.10; 95% CI: -3.78, -0.42; = 0.01) in an early stage of focal ischemic stroke in rodent models. Subgroup analyses showed effects of cathodal tDCS on infarct size were not varied by ischemia duration (ischemia for 1, 1.5, and 2 h or permanent ischemia) and anesthesia (involving isoflurane and ketamine). The overall quality of studies included was low, thus the results must be interpreted cautiously. Published studies suggest that cathodal tDCS may be a promising avenue to explore for augmenting rehabilitation from focal ischemic stroke. Considering the methodological limitations, it is unreliable to blindly extrapolate the animal data to the clinical practice. Future research is needed to investigate the mechanism of tDCS in a randomized and blinded fashion in clinically relevant stroke models, such as elderly animals, female animals, and animals with comorbidities, to find an optimal treatment protocol.

摘要

在临床研究中,梗死面积与中风严重程度相关,因此减小梗死面积已成为缺血性中风治疗的重要目标和研究热点。一些临床前研究表明,经颅直流电刺激(tDCS)可减小梗死面积并改善神经功能缺损,但其他研究并未发现其有益效果。此外,缺血性中风的tDCS最佳模式在很大程度上仍不清楚。为了阐明当前情况和未来研究方向,本系统评价评估了不同tDCS模式在减小缺血性中风啮齿动物模型梗死面积和改善神经功能缺损方面的效果,并评估了当前文献的方法学质量。我们检索了MEDLINE(PubMed)、EMBASE、Web of Science和Scopus数据库,检索时间从建库至2021年8月18日,以确定评估tDCS对缺血性中风啮齿动物模型影响的研究。纳入了8项研究,其中7项研究纳入了荟萃分析。结果显示,在啮齿动物模型局灶性缺血性中风早期,阴极tDCS而非阳极tDCS可减小主要通过四氮唑蓝和磁共振成像测量的梗死面积(标准化均数差:-1.13;95%可信区间:-1.72,-0.53;P = 0.0002),并改善通过改良神经功能严重程度评分评估的神经功能缺损(标准化均数差:-2.10;95%可信区间:-3.78,-0.42;P = 0.01)。亚组分析显示,阴极tDCS对梗死面积的影响不受缺血持续时间(缺血1、1.5和2小时或永久性缺血)和麻醉(包括异氟烷和氯胺酮)的影响。纳入研究的总体质量较低,因此对结果的解释必须谨慎。已发表的研究表明,阴极tDCS可能是探索增强局灶性缺血性中风康复效果的一个有前景的途径。考虑到方法学局限性,盲目将动物数据外推至临床实践是不可靠的。未来需要在临床相关的中风模型中,如老年动物、雌性动物和患有合并症的动物中,以随机和盲法研究tDCS的机制,以找到最佳治疗方案。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e622/8649802/ad67a14ab376/fnins-15-761971-g001.jpg

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