类固醇激素治疗突发性聋的Meta分析

Steroids for sudden sensorineural hearing loss:a meta-analysis

目的系统评价类固醇激素治疗突发性聋(sudden sensorineural hearingloss,SSNHL)的有效性和安全性。方法计算机检索Cochrane Library(2009年第4期)、PubMed(1966～2009.11)、EMBASE(1974～2009.11)、CBM(1978～2009.11)、CNKI(1994～2009.11)、VIP(1989～2009.11)和万方数据(1997～2009.11)。纳入类固醇激素治疗SSNHL的随机对照和半随机对照试验,按照Cochrane Handbook 5.0进行严格的质量评估,采用RevMan 5.0.2软件进行Meta分析。结果共纳入4个RCTs,3个Quasi-RCT,包括665例患者。Meta分析结果显示:地塞米松可明显提高即刻(治疗结束后6 d)听力恢复率(OR:2.60,P=0.00,95%CI:1.78-3.80),并可改善患者耳鸣的发生,但在治疗结束后3个月的听力恢复率和言语识别方面,差异均无统计学意义;泼尼松对治疗后即刻(治疗结束后6 d)和治疗结束后1个月的听力恢复率(分别为OR:0.86,P=0.86,95%CI:0.15-5.00,和OR:0.89,P=0.92,95%CI:0.10-7.86)差异均无统计学意义。结论地塞米松能显著提高听力恢复率,改善耳鸣的发生。但限于纳入研究的局限性,地塞米松对治疗结束后3个月的听力恢复率和言语识别,以及泼尼松在听力恢复率、耳鸣发生和言语识别方面的疗效尚不确定。

Objective To evaluate the efficacy and safety of steroid hormones in the treatment of sudden sensorineural hearing loss. Methods Randomized controlled trials（RCTs） and quasi-RCTs relating steroids in the treatment of sudden sensorineural hearing loss were identified from The Cochrane Library（the fourth issue of 2009）,PubMed（1966-Nov 2009）,EMBASE（1974-Nov 2009）,CBM（1978-Nov 2009）,CNKI（1994-Nov 2009）,VIP（1989-Nov 2009）,and WANFANG Databases（1997-Nov 2009）.The quality of included studies was assessed according to the criteria provided by Cochrane Collaboration.Meta-analyses were performed by RevMan 5.0.2 software. Results The study incorporated a total of four RCTs and three Quasi-RCTs,which included 665 participants.Meta-analyses illustrated that dexamethasone group had the tendency of improving tinnitus and increasing hearing recovery rate of immediate post-treatment,i.e.,6 days after the end of treatment（OR：2.60,P=0.00,95%CI：1.78-3.80）.While this group had no tendency of impoving speech discrimination and hearing recovery rate threes month after treatment.Meanwhile,prednisone group did not had the tendency of improving hearing recovery rate of immediate post-treatment（OR：0.86,P=0.86,95%CI：0.15-5.00） and one month after treatment（OR：0.89,P=0.92,95%CI：0.10-7.86）. Conclusions Compared with the control group,steroid hormones could significantly improve the hearing and the recovery rate of tinnitus.However,because of the limitation of sample size in this study,the clinical effect of prednisone on hearing recovery rate,tinnitus,speech and recognition remain uncertain.