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Lancet:口服泼尼松龙未能使分泌性中耳炎患者获益

2018-08-23 郑海珍 (江西省中医院) 信诺医讯

英国开展了本项多中心随机对照双盲试验OSTRICH,旨在评估短期口服泼尼松龙对此类患儿听力恢复的疗效和成本。

80%的4岁以下儿童患分泌性中耳炎,导致听力损失。此年龄段儿童语言功能发育最为迅速,听力损失对此影响严重。目前的治疗方法为观察等待,助听器或手术。助听器可导致患儿不适,产生自我患病意识,或使其成为被欺凌的对象。此外,安放助听器和手术治疗都需在二级医院进行,这额外增加了医疗成本。因此,一种可在社区诊所里实施的低耗,安全,有效的治疗手段意义重大。既往系统回顾显示口服类固醇对分泌性中耳炎有一定效果,但因纳入的研究普遍样本量小、质量低、周期短,口服类固醇未被推荐用于儿童分泌性中耳炎的治疗。



英国开展了本项多中心随机对照双盲试验OSTRICH,旨在评估短期口服泼尼松龙对此类患儿听力恢复的疗效和成本。研究者将389例2-8岁、病程≥3月、双侧听力缺失的分泌性中耳炎患儿,按1:1随机分配至口服泼尼松龙组(20mg/天或 30mg/天,7天)或安慰剂组。主要结局为5周时听力恢复至可接受的范围(定义为至少单耳纯音测试在0.5-4kHZ频率段平均听力损失≤20dB等)。结果显示,5周时,口服泼尼松龙和安慰剂组分别有183和180例患儿接受听力测试,两组各有40% vs 33%的患儿恢复到可接受的听力,组间无统计学差异(P=0.16)。两组在不良事件和生活质量评估方面亦无显着差异。

研究表明,病程≥3月的分泌性中耳炎患儿自主恢复听力损失和相关症状的几率极大。短期口服泼尼松龙,耐受性虽好,但未能使2-8岁患儿额外获益,仅有1/14的患儿听力可得到改善,但对生活质量无影响。本研究仍支持传统的观察等待等疗法。

原始出处:Nick A Francis, Rebecca Cannings-John, Cherry-Ann Waldron, et al. Oral steroids for resolution of otitis media with effusion in children (OSTRICH): a double-blinded, placebo-controlled randomised trial. The Lancet. AUGUST 18, 2018

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    2018-10-31 howi
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    2019-04-26 gwc392
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    2018-08-26 1e145228m78(暂无匿称)

    学习了,谢谢作者分享!

    0

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    2018-08-24 1e145228m78(暂无匿称)

    学习了,谢谢作者分享!

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1829769, encodeId=15201829e6901, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Wed Oct 31 19:12:00 CST 2018, time=2018-10-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1682453, encodeId=26ea1682453ff, content=<a href='/topic/show?id=d4d031e8074' target=_blank style='color:#2F92EE;'>#分泌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31780, encryptionId=d4d031e8074, topicName=分泌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0da227938338, createdName=gwc392, createdTime=Fri Apr 26 19:12:00 CST 2019, time=2019-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=341002, encodeId=16bf341002f9, content=学习了,谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Sun Aug 26 23:10:28 CST 2018, time=2018-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1344502, encodeId=399913445029b, content=<a href='/topic/show?id=a01b2239e0b' target=_blank style='color:#2F92EE;'>#中耳炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22397, encryptionId=a01b2239e0b, topicName=中耳炎)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/vLodSSFTQLpHtfwJicWJibSWH7pbiauxvpCMvQIv0N9Oes8vHkDkCIW2HNDkt7icUq3RCZiaDcHR9Rap17fFySRbiaFg/132, createdBy=9f202500205, createdName=ms3297076796458174, createdTime=Sat Aug 25 00:12:00 CST 2018, time=2018-08-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1553897, encodeId=bad1155389e73, content=<a href='/topic/show?id=adbe650e465' target=_blank style='color:#2F92EE;'>#泼尼松龙#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65074, encryptionId=adbe650e465, topicName=泼尼松龙)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fb4914457810, createdName=xjy07, createdTime=Sat Aug 25 00:12:00 CST 2018, time=2018-08-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340564, encodeId=fd273405641f, content=学习了,谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Fri Aug 24 13:35:00 CST 2018, time=2018-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340361, encodeId=280d3403610e, content=学习!, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9b2e1935437, createdName=AlexYang, createdTime=Thu Aug 23 11:14:15 CST 2018, time=2018-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340351, encodeId=1d6b3403515f, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=142, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Thu Aug 23 09:51:38 CST 2018, time=2018-08-23, status=1, ipAttribution=)]
    2018-08-23 AlexYang

    学习!

    0

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    2018-08-23 易水河

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