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

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

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。

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,P0.05）.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.