目的:评价鼓室内庆大霉素联合糖皮质激素治疗梅尼埃病(MD)的疗效及治疗后疗效。方法:基于PubMed和Embase数据库,使用鼓室注射4种药物(庆大霉素,甲基强的松龙,地塞米松,和安慰剂)从1995年至2023年10月进行了MD治疗,并根据纳入和排除标准筛选了文献,并使用Stata17对数据进行荟萃分析。结果:共选取13项研究,涉及559名参与者,随访时间3~28个月。Meta分析显示庆大霉素和地塞米松的纯音平均值差异无统计学意义[标准化平均差(SMD)=0.09,95%置信区间(CI)(-0.42,0.24),P<0.05]。与安慰剂相比,鼓室注射庆大霉素[风险比(RR)=1.18,95%CI(0.43,1.93)],甲基强的松龙[RR=0.88,95%CI(0.07,1.70)],和地塞米松[RR=0.70,95%CI(-0.01,1.41)]均显示出治疗眩晕的更好疗效。对于耳鸣的治疗,SUCRA排名结果表明,地塞米松是最有效的,其次是甲基强的松龙和庆大霉素。结论:药物干预治疗MD比安慰剂更有效。尽管庆大霉素治疗在治疗眩晕方面显示出显着效果,在控制听力损失和眩晕症状方面,皮质类固醇联合治疗明显优于庆大霉素。
Objective: Evaluation of the effectiveness and posttreatment effects of intratympanic gentamicin and corticosteroids in treating patients with Ménière\'s disease (MD). Methods: Based on PubMed and Embase databases, randomized controlled trials using intratympanic injections of 4 drugs (gentamicin,
methylprednisolone, dexamethasone, and placebo) for the treatment of MD were searched from 1995 to October 2023, and the literature was screened according to inclusion and exclusion criteria, and data were netted for meta-analysis using Stata 17. Results: A total of 13 studies were selected, involving 559 participants, with follow-up time ranging from 3 to 28 months. Meta-analysis showed that there was no statistically significant difference in pure-tone average between gentamicin and dexamethasone [standardized mean difference (SMD) = 0.09, 95% confidence interval (CI) (-0.42, 0.24), P < .05]. Compared to placebo, intratympanic injection of gentamicin [risk ratio (RR) = 1.18, 95% CI (0.43, 1.93)],
methylprednisolone [RR = 0.88, 95% CI (0.07, 1.70)], and dexamethasone [RR = 0.70, 95% CI (-0.01, 1.41)] all showed better efficacy in treating vertigo. For the treatment of tinnitus, the SUCRA ranking results showed that dexamethasone was the most effective, followed by
methylprednisolone and gentamicin. Conclusion: Pharmacological intervention is more effective than placebo in treating MD. Although gentamicin treatment shows significant effects in treating vertigo, corticosteroid combination therapy is markedly superior to gentamicin in controlling hearing loss and vertigo symptoms.