激素和抗病毒药物治疗特发性面神经麻痹的网状Meta分析

Corticosteroid and antiviral agents for idiopathic facial nerve paralysis:a network metaanalysis

目的采用网状Meta分析方法评价激素和抗病毒药物治疗特发性面神经麻痹(idiopathic facial nerve paralysis,IFNP)的有效性和安全性。方法计算机检索PubMed、EMbase、The Cochrane Library、CBM、CNKI、WanFang Data和VIP数据库,搜集有关激素和抗病毒药物治疗IFNP的随机对照试验(randomized controlled trial,RCT),检索时限均从建库至2018年1月31日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用R 3.3.3和Stata 13.0软件进行统计分析。结果共纳入16个RCT,包括3 061例患者。网状Meta分析结果显示:在面部功能恢复方面,随访至3个月时,激素与抗病毒药物联合治疗优于安慰剂或单用抗病毒药物;6个月时,激素与抗病毒药物联合治疗优于使用安慰剂、单用抗病毒药物或单用激素(针对满意恢复定义为House-Brackmann等级≤Ⅱ级);超过6个月时,单用激素优于仅使用安慰剂或单用抗病毒药物,激素与抗病毒药物联合治疗优于仅使用安慰剂或单用抗病毒药物,以上差异均有统计学意义。在后遗症方面,激素与抗病毒药物联合治疗和单用激素优于仅使用安慰剂或单用抗病毒药物,激素与抗病毒药物联合治疗优于单用激素,差异均有统计学意义。在不良反应方面,不同治疗组的差异均无统计学意义。结论在激素基础上加用抗病毒药物治疗IFNP的患者面部功能恢复可能更好,出现后遗症的可能性更小,次之为单用激素。受纳入研究数量和质量限制,上述结论尚待更多高质量研究予以验证,同时应重点关注儿童患者群体和临床表现严重的面瘫患者群体。

ObjectivesTo assess the efficacy and safety of corticosteroid and antiviral agents for idiopathic facial nerve paralysis （IFNP） by network meta-analysis.MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, WangFang Data and VIP databases were electronically searched to collect randomized controlled trials （RCTs） of corticosteroid and antiviral agents for IFNP from inception to January 31th, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. The meta-analysis was performed by R 3.3.3 and Stata 13.0 software.ResultsA total of 16 RCTs involving 3 061 patients were included. The results of network meta-analysis showed that： for the facial function recovery rates, corticosteroid plus antiviral agents was superior to placebo and antiviral agents alone at 3-month follow-up. Corticosteroid plus antiviral agents was superior to placebo, antiviral agents or corticosteroid alone at 6-month follow-up （if the satisfactory recovery was defined as a House-Brackmann grade class Ⅱ or below）. When the follow-up exceeded 6 months, corticosteroid alone was superior to placebo and antiviral agents alone, corticosteroid plus antiviral agents was superior to placebo and antiviral agents alone. All of the differences above were statistically significant. For the sequelae, corticosteroid plus antiviral agents and corticosteroid alone were superior to placebo and antiviral agents alone. Corticosteroid plus antiviral agents was superior to corticosteroid alone. The differences were statistically significant. For the adverse events, there were no significant differences between any other pairwise comparisons of these different interventions.ConclusionConsidering the efficacy and safety, patients with IFNP treated corticosteroid plus antiviral agents are more likely to have a better recovery of facial function and less likely to develop sequelae, followed by corticosteroid alone. More high-quality, large scaled and multicenter RCTs are required to verify the conclusions above, and focus on the treatment of children and patients with severe facial paralysis.