鼓室内灌注类固醇激素治疗特发性耳聋疗效的Meta分析

发布时间：2018-04-22 13:29

本文选题：鼓室内灌注类固醇激素 + 类固醇激素　；参考：《广西医科大学》2011年硕士论文

【摘要】：目的鼓室内灌注类固醇激素治疗是目前可以用来替代全身系统性使用类固醇激素治疗特发性聋的一种较有前途的治疗方法。然而,不同的研究之间的结果不同。本文的目的是对鼓室内灌注类固醇激素与不同治疗方法治疗特发性耳聋的疗效分析。方法检索Medline和Embase数据库,两位分析员独立评价文献并提取数据,采用Stata11.0软件进行Meta分析。结果通过检索策略检索出142篇文献,最后纳入8个随机对照试验,其中4个试验纳入的是首次治疗特发性耳聋患者,4个试验纳入的是经全身系统性运用类固醇激素治疗失败后的患者。在首次治疗的4个试验中有2个试验是鼓室内灌注类固醇激素与口服类固醇激素的疗效对比,1个试验是鼓室内灌注、鼓室内灌注加口服类固醇激素与口服类固醇激素三者的疗效对比,而该试验按作两个试验提取数据,即鼓室内灌注类固醇激素对比口服类固醇激素和鼓室内灌注加口服类固醇激素对比口服类固醇激素,最后1个试验是鼓室内灌注加口服类固醇激素与口服类固醇激素的疗效对比。在鼓室内灌注类固醇激素与口服类固醇激素首次治疗疗效对比的3个试验中,分析结果显示前者稍优于后者,但无显著性统计学差异(RR=1.22,95% CI 0.98至1.52,p=0.071)；在经全身系统性使用类固醇激素治疗失败后使用鼓室内灌注类固醇激素与对照组(有的为除激素外的其他常规治疗对照,有的为安慰剂对照而有的以不再作进一步的处理作为对照)的4个随机对照试验的分析结果显示,实验组明显优于对照组并且有显著的统计学差异(RR=8.73,95% CI为2.46至30.92,p=0.001)。然而在2个对比鼓室内灌注加口服类固醇激素与口服类固醇激素的疗效的试验中,由于存在显著的异质性(χ2=4.45,p=0.035,12=77.5%),故未进行Meta分析。此外,在全部8个试验中有243例接受了鼓室内灌注处理,但只有2例发生了鼓膜穿孔,经修补后均能治愈。结论对于不能耐受全身系统性使用类固醇激素的患者,鼓室内灌注类固醇激素是一个很好的替代方法,即使是经过全身系统性使用类固醇激素失败后的患者,鼓室内灌注类固醇激素仍是一个不错的挽救性治疗方法,并且这一操作在临床上是相对安全的。
[Abstract]:Objective Intratympanic steroid therapy is a promising alternative to systemic steroid hormone therapy for idiopathic deafness. However, the results vary from study to study. The purpose of this paper is to analyze the therapeutic effect of intratympanic infusion of steroid hormone and different treatment methods on idiopathic deafness. Methods Medline and Embase databases were searched. The two analysts independently evaluated the literature and extracted the data. Stata11.0 software was used for Meta analysis. Results 142 articles were retrieved by search strategy, and were included in 8 randomized controlled trials. Four of the trials involved the first treatment of idiopathic deafness and four included patients who had failed in systemic steroid therapy. Two of the first four trials were compared with oral steroid hormone infusion in the tympanic cavity, and one was in the tympanic cavity. The effects of intratympanic perfusion plus oral steroid hormone and oral steroid hormone were compared, and the data were extracted from two trials. That is, intratympanic infusion of steroid hormone versus oral steroid hormone and intratympanic perfusion plus oral steroid hormone versus oral steroid hormone, The final trial was a comparison of the effects of intratympanic perfusion with oral steroid hormones and oral steroid hormones. In three trials in which intratympanic steroids were infused with oral steroids for the first time, the results showed that the former was slightly better than the latter. However, there was no significant statistical difference between RRX 1.22 95% CI 0.98 to 1.52p0.071%, and after systemic steroid hormone therapy failed, intratympanic instillation of steroid hormone was given to the control group (some of which were compared with those of the control group). The results of four randomized controlled trials with placebo control and no further treatment showed that the experimental group was significantly superior to the control group and had a significant statistical difference between 2.46 and 30.92p0.001of RRN 8.7395% CI. However, Meta analysis was not carried out in two tests comparing the effects of intratympanic perfusion with oral steroid hormones and oral steroid hormones because of the significant heterogeneity (蠂 ~ 24.45). In addition, 243 cases were treated with intratympanic perfusion in all 8 trials, but only 2 cases had tympanic membrane perforation, all of which could be cured after repair. Conclusion Intratympanic instillation of steroid hormone is a good alternative for patients who cannot tolerate systemic steroid hormone use, even after systemic steroid use failure. Intratympanic steroid infusion is still a good rescue therapy, and this procedure is relatively safe clinically.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R764.43

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