鼓室内注射甲强龙治疗糖尿病突发性聋

Preliminary study on intratympanic methylprednisolone injection for management of type 2 diabetes patients with sudden hearing loss

目的评价鼓室内注射甲强龙治疗2型糖尿病突发性聋的效果。方法以发病1周内,未接受任何治疗的2型糖尿病突发性聋患者82例作为研究对象,随机分成局部激素组和全身激素组。局部激素采用鼓室内注射甲强龙0.5 ml(40 mg/ml),每天1次,共10 d。全身激素治疗采用甲强龙100 mg/d静脉滴注,连用3 d,随后60 mg/d,连用3 d,最后40 mg/d,连用4 d。同时两组均用扩血管、改善微循环、营养神经的药物治疗和混合氧治疗。获取治疗后第10、20、30 d纯音听力测试结果进行疗效评估。结果治疗前影响预后的因素在两组间良好匹配。两组患者治疗过程中血糖变化:局部激素组血糖在空腹(t=3.95)、餐后2 h(t=4.50)和晚10点(t=4.28)均较全身激素组低,差异均有统计学意义(P<0.05)。治疗后纯音听阈均值(pure tone average,PTA)改善≥30 dB者所占比例,局部激素组80%,全身激素组66.67%,两组之间的差异无统计学意义(P>0.05);治疗30 d后PTA改善值分别为:局部激素组42 dB、全身激素组35 dB,两组间差异有统计学意义(t=2.19,P=0.019)。两组患者治疗后10 d听力提高最明显,20 d听力基本稳定。结论局部激素治疗2型糖尿病突发性聋更加安全有效。

OBJECTIVE To investigate the efficacy of intratympanic methylprednisolone injection for type 2 diabetes patients with sudden hearing loss. METHODS Eighty two type 2 diabetes patients developing sudden hearing loss in a week without any treatment were divided randomly into two groups： local steroid group and general steroid group. Patients in local steroid group were injected 0.5 ml methylprednisolone （40 mg/ml） into middle ear qd at a course of 10 days. Patients in general hormone group were treated by intravenous drip methylprednisolone at a course of 100mg qd for 3 days, 60mg qd for 3days, 40 mg qd for 4 days. All patients were treated by drugs improving microcirculation, dialating blood vessel, nourishing nerve and oxygen therapy. Pure-tone averages （PTA） was used to evaluate the efficacy at the 10th day, 20th day, 30th day after the treatment. RESULTS Factors affecting the prognosis matched well between the two groups before treatment. The blood sugar [limosis （t=3.95） , postprandial 2 h （t=4.50） , 10PM （t=4.28） ] was lower in local steroid group than that of general steroid group in the therapy course, and had statistical significance （P〈0.05） . The proportion of improvement of PTA≥30 dB was 80% in local steroid group and 66.67% in general steroid group, and had no statistical significance （P〉0.05） . The improvement of PTA at the 30th day after treatment was 42 dB in local steroid group and 35 dB in general steroid group, and had statistical significance （t=2.19, P=0.019） .The evident improvement of PTA appeared at the 10th day after treatment, and was stable at the 20th day. CONCLUSION The local steroid therapy is safer and more effective in treating type 2 diabetes patients with sudden hearing loss.