目的:评价氯沙坦对前庭神经鞘瘤(VS)生长及相关听力损失的影响。
方法:回顾性队列研究。
方法:三级转诊中心。
方法:散发性VS患者接受至少两次磁共振成像和听力学检查的初步观察。
方法:氯沙坦。
方法:终点包括VS增长,定量听力学变化,无肿瘤生长存活,和生存没有无用的听力。通过使用氯沙坦比较患者特征和终点。
结果:纳入了79名患者,其中33%服用氯沙坦。在氯沙坦组中50%的患者和非氯沙坦组中36%的患者中观察到肿瘤生长(p=0.329)。生存分析未能显示组间VS生长危险率的显著差异(风险比,1.38;95%置信区间,0.70-2.70;p=0.346)。在整个观察过程中,在氯沙坦和非氯沙坦组中,归一化纯音平均值的平均下降为5.5和9.3dB,分别(p=0.908)。在氯沙坦和非氯沙坦组中,标准化单词识别得分的平均下降分别为11.0%和16.6%,分别(p=0.757)。氯沙坦组19%的患者和非氯沙坦组28%的患者出现了不可用的听力(p=0.734)。生存分析并没有证明在群体之间发展不可用听力的危险率存在显著差异(风险比,1.71;95%置信区间,0.56-5.21;p=0.337)。
结论:使用氯沙坦可能不会降低观察期间VS生长或听力损失的风险。随机试验将是进一步确定对生长和听力的真正影响的理想选择。
OBJECTIVE: To evaluate the impact of losartan on vestibular schwannoma (VS) growth and related hearing loss during observation.
METHODS: Retrospective cohort study.
METHODS: Tertiary referral center.
METHODS: Sporadic VS patients undergoing initial observation with at least two magnetic resonance imaging and audiologic examinations.
METHODS: Losartan.
METHODS: Endpoints included VS growth, quantitative audiologic changes, survival free of tumor growth, and survival free of nonserviceable hearing. Patient characteristics and endpoints were compared by losartan use.
RESULTS: Seventy-nine patients were included, of which 33% were taking losartan. Tumor growth was observed in 50% of patients in the losartan group and 36% in the non-losartan group (p = 0.329). Survival analysis failed to show a significant difference in the hazard rate of VS growth between groups (hazard ratio, 1.38; 95% confidence interval, 0.70-2.70; p = 0.346). Throughout observation, mean decreases in normalized pure-tone average were 5.5 and 9.3 dB in the losartan and non-losartan groups, respectively (p = 0.908). Mean decreases in normalized word recognition score were 11.0 and 16.6% in the losartan and non-losartan groups, respectively (p = 0.757). Nonserviceable hearing developed in 19% of patients in the losartan group and 28% in the non-losartan group (p = 0.734). Survival analysis did not demonstrate a significant difference in the hazard rate of developing nonserviceable hearing between groups (hazard ratio, 1.71; 95% confidence interval, 0.56-5.21; p = 0.337).
CONCLUSIONS: Losartan use may not reduce the risk of VS growth or hearing loss during observation. A randomized trial would be ideal to further identify the true effect on growth and hearing.