糖皮质激素经鼓膜与经口途径在治疗突聋上的疗效分析

【作者】 余啸； 高金建； 陈迎迎； 项海杰； 章誉耀； 陈思； 陈波蓓；

【机构】 温州医学院附属第二医院耳鼻咽喉科；

【摘要】 目的:通过对现有文献的系统性回顾,比较经鼓膜糖皮质激素疗法(ITS)与经口糖皮质激素疗法在治疗突发性感音神经性聋(SSHL)的差异。数据来源:在线数据库包括Medline,EMBASE,CochraneReview。回顾方法:纳入符合标准的治疗突发性聋的随机对照试验,对纳入研究的质量进行系统性回顾。结果:作者筛选了69篇文献,其中符合标准的文献7篇。在限定两种疗法的剂量、疗程、频次后,meta分析示ITS组受试者平均纯音听阈(PTA)改善较经口糖皮质激素组搞11.13dB(95%可信区间[CI],9.16-13.1 1,P<0.00001;Chi2=2.44,df=2,P=0.30,I2=18%)。结论:虽然评估ITS治疗SSHL的高质量研究有限,但其作为第一线治疗组在PTA改善和恢复率上优于受限制的条件下口服类固醇组(口服类固醇给药时间≤10天,类固醇浓度60mg/kg/d,和注射的次数是4到5倍之间在ITS)。更多还原

【Abstract】 Object:To determine the evidence for efficacy of intratympanic steroid(ITS) versus oral steroid treatment for the management of sudden sensorineural hearing loss(SSHL) through a systematic review of the existing literatures.Data Sources:Online databases consisting of Medline,EMBASE,Cochrane Review,and collected additional publications cited in bibliographies.Review Methods:Literature search by both authors with structured criteria to select studies evaluated for systematic review.Results:The authors identified 69 articles,of which 7 represented studies of ITS versus oral steroids treatment for the management of sudden hearing loss.Despite the paucity of well-executed trials,the vast majority of studies demonstrated a benefit of ITS better than oral steroid treatment.A meta-analysis of the limited studies revealed a mean difference in PTA improvement of 11.13 dB(95%confidence interval[CI],9.16-13.11,P<0.00001;Chi~2 = 2.44,df =2,P =0.30,I~2=18%).These indicate acceptance of the null hypothesis that the studies share a common effect size. Conclusion:Although very few high-quality studies exist that evaluate the benefit of intratympanic steroids for treating SSHL,limited high-quality studies selected in this review showed that the ITS group as a first-line therapy in the PTA improvement and the recovery rate is superior to the oral steroid group under some restricted conditions(oral steroid administration time<10 days and steroid concentration is about 60mg/kg/d, and the number of injections was between 4 to 5 times in ITS).更多还原