糖皮质激素鼓室给药治疗突发性聋的系统评价

Intratympanic Glucocorticoids for Sudden Sensorineural Hearing Loss: A Systematic Review

摘要: 目的：系统评价糖皮质激素鼓室注射治疗突发性聋的有效性及安全性，为临床决策提供切实有效的依据。 方法：检索 Cochrane Library, PubMed, EMBASE, CBM, CNKI, VIP及万方等数据库的中英文文献。纳入糖皮质激素鼓室注射(ITD)vs 对照组（全身糖皮质激素/安慰剂治疗）的随机对照试验(RCT)。根据 Cochrane Handbook 5.0.1 标准对纳入研究进行质量评价，用 RevMan 5.0.2 软件进行Meta 分析。结果：纳入5 个 RCTs，共 285 例患者。Meta 分析示，两组听力恢复率差异有统计学意义OR(95% CI)为3.94(1.03,15.12)，糖皮质激素鼓室注射组(ITD)在250 HZ处较对照组表现出显著地听力恢复(p < 0.05)。与对照组相比，在言语接受阈方面，差异无统计学意义(p = 0.20)。结论：糖皮质激素鼓室注射可显著提高患者听力恢复率，但由于本系统评价纳入研究的样本数量有限，上述结论尚需进行近一步验证。

Abstract: Objective To assess the efficacy and safety of intratympanic glucocorticoids for sudden sensorineural hearing loss. Methods We searched the Cochrane Library, PubMed, EMBASE, CBM,CNKI, and VIP databases and International Clinical Trials Registry website of World Health Organization using the key words “glucocorticoids”, “hearing loss” for the literatures of English and Chinese. Randomized controlled trials (RCTs) of intratympanic glucocorticoids versus placebo or intratympanic glucocorticoids versus controlled group（oral glucocorticoid/placebo）for sudden sensorineural hearing loss were included. According to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1, we assessed the quality of the included RCTs. A meta-analysis was carried out with the Cochrane Collaboration’s software RevMan 5.0.2. Results Five RCTs which contained 285 patients were included. Meta-analysis illustrated that there was sta-tistically significant on hearing recovery rate between the two groups (OR:3.94, 95% CI: 1.03-15.12). Hearing of pure tone average also improved significantly with intratympanic glucocorticoids therapy at 250HZ (p < 0.05). We found no statistically significant on the speech reception threshold (p = 0.20). Conclusion Com-pared with the control group, intratympanic glucocorticoids can significantly increase the hearing recovery rate of patients. Given the limitation of sample size of included studies into consideration, the results of this systematic review are still uncertain. Multi-center, large-scale, double-blinded randomized control trials are needed to confirm the available evidence.