糖皮质激素治疗急性低频感音神经性聋疗效的对比分析

A comparative study on efficacy of glucocorticoids in patients suffering acute low-tone sensorineural hearing loss

目的研究糖皮质激素对急性低频感音神经性聋(acute low-tone sensorineural hearing loss,ALHL)的治疗作用,为临床提供循证医学依据。方法记录200耳的耳蜗电图,按耳蜗电图结果分为-SP/AP≥0.4组(110耳)和-SP/AP<0.4组(90耳)。上述两组分别采用随机单盲的方式,分别采用全身激素治疗、局部激素治疗和不用激素治疗,-SP/AP≥0.4组中分别40、37、33耳,-SP/AP<0.4组中分别34、30、26耳。对比各组疗效。结果55%的ALHL患者-SP/AP比值异常增高。-SP/AP≥0.4组中,全身激素治疗、局部激素治疗和不用激素治疗患者有效率分别为92.50%、94.59%及72.73%,其中全身激素治疗与局部激素治疗患者比较,无统计学差异(P>0.05),而全身激素治疗和局部激素治疗患者分别与不用激素治疗患者对比,差异具有统计学意义(P≤0.05)。-SP/AP<0.4组中,全身激素治疗、局部激素治疗和不用激素治疗患者疗效无统计学差异(P>0.05)。结论-SP/AP≥0.4组中,使用激素治疗患者的疗效优于不用激素者,而全身激素治疗和局部激素治疗疗效相当。-SP/AP<0.4组,全身激素治疗、局部激素治疗和不用激素治疗患疗效相当。

OBJECTIVE To investigate the therapeutic role of glucocorticoids in acute low-tone sensorineural hearing loss and to guide clinical management.METHODS Recorded electrocochleograms in 200 ears.Based on the results,these patients were divided into-SP/AP≥0.4 with 110 ears and-SP/AP<0.4 with 90 ears.In a randomized,single-blind fashion,the two groups were divided into systemic,local,and non-glucocorticoid-treated groups separately.We compared treatment effects between different groups.RESULTS The-SP/AP ratios are abnormally increased in 55%of ALHL patients.In patients with-SP/AP≥0.4,the effective treatment rates of systemic,local and non-glucocorticoid groups were 92.50%,94.59%and 72.73%,respectively.A comparison between systemic and local glucocorticoid delivery regimes,P>0.05,and the two groups were compared with the non-glucocorticoid group,P≤0.05.In patients with-SP/AP<0.4,compared the efficacy of the three groups,P>0.05.CONCLUSION In patients with-SP/AP≥0.4,glucocorticoids are more effective than non-glucocorticoid,systemic glucocorticoids are as effective as local glucocorticoids.In patients with-SP/AP<0.4,In contrast,systemic,local and non glucocorticoids are equally effective.