皮质类固醇激素治疗前庭神经炎疗效的Meta分析

Meta Analysis of the Effect of Corticosteroids in the Treatment of Vestibular Neuritis

目的系统评价皮质类固醇激素治疗前庭神经炎(vestibular neuritis,VN)的临床疗效,为临床使用皮质类固醇激素治疗VN提供参考。方法通过检索中国知网、万方、维普、Web of science、EMBASE、Cochrane library、Pubmed数据库,根据纳入和排除标准筛选关于皮质类固醇激素治疗前庭神经炎的相关文献,所有研究对象分为激素组和对照组,结局评价指标为冷热试验半规管轻瘫(canal paresis,CP)值、眩晕残障程度评定量表(dizziness handicap inventory,DHI)评分以及住院时间,采用严格文献质量方法学标准进行评价,应用RevMan5.3软件进行Meta分析。结果最终纳入9篇文献,共426例患者,其中激素组189例,对照组237例。Meta分析结果显示治疗后1、6、12个月,两组患者CP值风险比(relative risk,RR)值分别为1.80、95%Cl(0.70,4.63)、1.01、95%Cl(0.74,1.39)和1.54、95%Cl(0.88,2.69),差异无统计学意义(P>0.05);治疗后1个月,两组患者DHI评分差异无统计学意义[MD=3.36,95%Cl(-4.93,11.65),Z=0.80,P>0.05],治疗后6个月DHI评分的差异有统计学意义[MD=-2.41,95%Cl(-4.29,-0.53),Z=2.52,P=<0.05];两组患者住院时间比较差异有统计学意义[MD=-0.92,95%Cl(-1.37,-0.47),Z=4.04,P<0.0001]。结论皮质类固醇激素治疗VN能有效缩短住院时间,但在临床症状及前庭功能恢复方面并不优于对照组。

Objective To systematically evaluate the clinical efficacy of corticosteroids in the treatment of vestibular neuritis,and to provide a reference for the feasibility of using corticosteroids in the treatment of vestibular neuritis.Methods Literature about corticosteroid trentment of vestibular neuritis were searched in CNKI,Wanfang systematiclly,VIP,web of science,EMBASE,Cochrane Library,PubMed database and screened by our inclusion and exclusion criteria.All the research objects were divided into corticosterords group and control group.The outcome index included the value of patients with canal paresis(CP),the score of dizziness handicap inventory and the length of hospital stay.Strict literature quality methodology standard and Revman 5.3 software were used for the meta analysis.Results Nine clinical literatures were included,including 7 RCT articles and 2 RCS articles.A total of 426 patients were involved,including 189 in the corticosteroids group and 237 in the control group.Meta results showed that 1,6 and 12 months after treatment,the RR of the canal paresis(CP)in the two groups were 1.80,95%Cl(0.70,4.63),1.01,95%Cl(0.74,1.39)and 1.54,95%Cl(0.88,2.69),respectively,and the differences were not statistically significant(all P values were>0.05).1 month after treatment,there was no statistically significant difference in dizziness handicap inventory(DHI)scores between the two groups[MD=3.36,95%Cl(-4.93,11.65),Z=0.80,P=0.43>0.05],and there was a statistically significant difference in DHI scores 6 months after treatment[MD=-2.41,95%Cl(-4.29,-0.53),Z=2.52,P=0.01<0.05].The difference in length of stay between the two groups was statistically significant[MD=-0.92,95%Cl(-1.37,-0.47),Z=4.04,P<0.0001].Conclusion Corticosteroids therapy can effectively shorten the length of hospital stay,but in the aspect of clinical symptoms and recovery of vestibular function are not better than the control group.