鼓室内与全身应用激素初始治疗突发性聋疗效的系统评价和Meta分析

陈鹏; 王世飞; 张钰; 黄晗; 张春林; 肖政

doi:10.13201/j.issn.1001-1781.2015.22.010

鼓室内与全身应用激素初始治疗突发性聋疗效的系统评价和Meta分析

- 1. 遵义医学院附属医院耳鼻咽喉科(贵州遵义, 563003);
- 2. 遵义医学院基础药理教育部省部共建重点实验室;
- 3. 遵义医学院附属医院遵义医学院循证医学中心

详细信息

通讯作者: 王世飞,E-mail:wsf5511@126.com

中图分类号: R764.43

收稿日期: 2015-07-02

Intratympanic versus systemic steroid initial treatment for idiopathic sudden hearing loss:a Meta-analysis

- 1 Department of Otolaryngology, the Affliated Hospital of Zunyi Medical College, Zunyi, 563003, China;
- 2 Department of Pharmacology, Key Lab of Basic Pharmacology of Ministry of Education, Zunyi Medical College;
- 3 Affliated Hospital of Zunyi Medical College, Center for Evidence Based Medicine

More Information

Corresponding author: WANG Shifei, E-mail: wsf5511@126.com

Received Date: 02 July 2015

摘要

摘要: 目的: 系统评价比较鼓室内和全身应用糖皮质激素初始治疗突发性聋的有效性和安全性。方法: 电子检索 PubMed、Embase、Cochrane、CBM、CNKI、维普、万方数据库,系统地收集2015年5月份以前,关于鼓室内和全身应用糖皮质激素用于突发性聋初始治疗的随机对照试验,对符合入选标准的文献提取资料进行Meta分析。结果: 共纳入11篇RCT,共1298例受试者,鼓室注射组521例,静脉滴注组410例,口服治疗组201例,Meta分析显示:鼓室内用药组与全身用药组在治疗突发性聋的有效率及显著改善率方面,组间差异有统计学意义;鼓室用药组的有效率高于全身用药组的有效率(P>0.05)。鼓室注射与口服激素治疗差异无统计学意义(P>0.05);鼓室注射与静脉滴用药相比差异有统计学意义(RR=1.17,95%CI为1.02~1.34, P<0.05),鼓室注射治疗的有效率高于静脉用药治疗的有效率(P>0.05);鼓室用药组不良反应主要为注射疼痛、眩晕,其并发症发生率较全身用药组高;全身用药组主要不良反应为血糖升高,影响饮食、睡眠,其并发症发生率较鼓室注射组高。结论: 鼓室注射激素治疗突发性聋虽有更高的有效率和显著改善率,但因缺乏进一步深入研究,故尚不建议患者优先考虑。
- 突发性聋 /
- 糖皮质激素 /
- 随机对照 /
- Meta分析
Abstract: Objective: To assess the efficacy and safety of glucocorticoid in initial treatment of sudden hearing loss with intratympanic (IT) and systemic ways.Method: We searched the database of PubMed,Cochrane,Embase,CBM, CNKI, VIP, Wanfang systematically. Literatures were screened according to the preestablished inclusion and exclusion standards,and all the RCT literatures associated with intratympanic and systemic glucocorticoid in the initial treatment of sudden hearing loss before may 2015 were collected. All the data,which meet the inclusion standards, were analyzed by using Meta-analysis software.Result: Among all the qualified literatures,11 randomized controlled trials were included. A total of 1298 cases were involved, including 521 cases with intratympanic administration, 410 with Ⅳ-therapy, and 201 with oral therapy. Meta analysis results showed that there was significant difference of the total effective rate and improvement rate between the intratympanic and systemic administration. Intratympanic injection (P>0.05) was more effective than systemic administration. There was no significant difference between intratympanic group and oral group (RR=1.15,95%CI:0.92-1.42, P>0.05). A significant difference of the effective rate occurred between intratympanic group and Ⅳ therapy group (RR=1.17,95%CI:1.02-1.34, P<0.05).The major complications of intratympanic were pain, dizziness/vertigo,which occurred more frequently than systemic therapy group; The major complications of systemic therapy group were hyperglycaemia, loss of appetite and insomnia.Conclusion: This study shows that the intratympanic (IT) glucocorticoid for sudden deafness is more effective than the systemic administration. But it was not the first choice in clinical treatment.Further studies are warranted.
- sudden hearing loss /
- steroid /
- glucocorticoid /
- RCT

HTML全文

参考文献(21)

[1]	MICHEL O. The revised version of the german guidelines "sudden idiopathic sensorineural hearing loss" [J]. Laryngorhinootologie,2011,90:290-293.
[2]	STACHLER R J,CHANDRASEKHAR S S,ARCHER S M, et al. Clinical practice guideline sudden hearing loss[J].Otol Head Neck Surg, 2012,146:S1-S35.
[3]	彭易坤,熊世珍,程永华,等.不同途径给地塞米松治疗突发性聋的临床研究[J].临床耳鼻咽喉头颈外科杂志, 2008,22(10):442-445.
[4]	赵晖,张天宇,傅窈窈,等.鼓室内注射地塞米松治疗极重度以上突发性聋的临床研究[J].中华耳鼻咽喉头颈外科杂志, 2009, 44(4):297-301.
[5]	屈永涛,陈红耀,张慧平,等.不同途径激素给药治疗突发性聋的疗效分析[J].临床耳鼻咽喉头颈外科杂志, 2015,4(1):8-8.
[6]	DISPENZA F,AMODIO E,DE STEFANO A, et al. Treatment of sudden sensorineural hearing loss with transtympanic injection of steroids as single therapy:a randomized clinical study[J].European Archives Otorhinol, 2011, 268:1273-1278.
[7]	LIM H J,KIM Y T,CHOI S J, et al. Efficacy of 3 Different Steroid Treatments for Sudden Sensorineural Hearing Loss A Prospective, Randomized Trial[J].Otol Head Neck Surg, 2013, 148:121-127.
[8]	KOSYAKOV S,ATANESYAN A,GUNENKOV A, et al. Intratympanic steroids for sudden sensorineural hearing loss[J].Int Adv Otol, 2011,7:323-332.
[9]	BATTAGLIA A,BURCHETTE R,CUEVA R.Combination therapy (intratympanic dexamethasone+high-dose prednisone taper) for the treatment of idiopathic sudden sensorineural hearing loss[J].Otol Neurotol, 2008,29:453-460.
[10]	RAUCH S D,HALPIN C F,ANTONELLI P J, et al. Oral vs intratympanic corticosteroid therapy for idiopathic sudden sensorineural hearing loss:a randomized trial[J].Jama,2011,305:2071-2079.
[11]	李晖,刘莉,郭筠芳.鼓室注射地塞米松治疗突发性聋的疗效及影响因素分析[J].听力学及言语疾病杂志, 2013, 21(5):539-541.
[12]	李欣,王锐,姜子刚,等.影响鼓室内激素治疗突发性聋的多因素分析[J].中华耳科学杂志, 2010,8(4):437-440.
[13]	王春花,李立群,李玉环,等.甲基强的松龙鼓室注射与全身应用治疗突发性聋的疗效比较[J].听力学及言语疾病杂志, 2014,22(2):201-203.
[14]	FILIPO R,ATTANASIO G,RUSSO F Y, et al. Oral versus short-term intratympanic prednisolone therapy for idiopathic sudden hearing loss[J].Audiol Neurotol, 2014, 19:225-233.
[15]	HIGGINS JPT, GREEN S (editors). Assessing risk of bias in included studies. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2[updated September 2009] ; Section 8. The Cochrane Collaboration, 2008. Available from www.cochrane-handbook.org.
[16]	头颈外科杂志编辑委员会中华耳鼻咽喉,头颈外科分会中华医学会耳鼻咽喉.突发性聋诊断和治疗指南(2005年济南)[J].中华耳鼻咽喉-头颈外科杂志,2006,41(8):569-569.
[17]	《中华耳鼻咽喉科杂志》编委会.突发性聋诊断依据和疗效分级[J].中华耳鼻咽喉科杂志,1997,32(2):73-73.
[18]	YANG J,WU H, ZHANG P, et al. The pharmacokinetic profiles of dexamethasone and methylprednisolone concentration in perilymph and plasma following systemic and local administration[J].Acta Otolaryngol,2008,128:496-504.
[19]	ITO S,FUSE T,YOKOTA M,et al. Prognosis is predicted by early hearing improvement in patients with idiopathic sudden sensorineural hearing loss[J].Clin Otolaryngol Allied Sciences,2002,27:501-504.
[20]	余力生,杨仕明,韩东一,等.中国突发性聋分型治疗的多中心临床研究[J]. 2013,48(5):355-361.
[21]	张萍,吴皓,杨军,等.不同途径给药后血浆和外淋巴液中甲泼尼龙的代谢动力学特征[J].临床耳鼻咽喉科杂志,2006,19(22):1040-1043.