Fujiwara Takashi, Haku Yasuharu, Miyazaki Takuya, Yoshida Atsuhiro, Sato Shin-Ich, Tamaki Hisanobu
Department of Otolaryngology Head and Neck Surgery, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki, Okayama 710-8602, Japan.
Department of Otolaryngology Head and Neck Surgery, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki, Okayama 710-8602, Japan.
Auris Nasus Larynx. 2018 Jun;45(3):465-470. doi: 10.1016/j.anl.2017.09.008. Epub 2017 Sep 22.
The aim of this study was to evaluate the effectiveness of high-dose corticosteroid (120mg prednisolone equivalent daily) in Bell's palsy compared with low-dose corticosteroid (60mg PSL equivalent).
A single-center retrospective observational study was performed. We included adult Bell's palsy patients who were treated within 7days after disease onset. We compared high- and low-dose corticosteroid for the non-recovery rate at 6 months after disease onset using inverse probability-weighted propensity score analysis (IPW-PS).
A total of 368 Bell's palsy patients (281 in the high-dose and 87 in the low-dose group) were included. The non-recovery rate without IPW-PS was 13.8% in the low-dose and 8.2% in the high-dose group. After IPW-PS adjustment, the non-recovery rate was 13.1% in the low-dose and 7.8% in the high-dose group (difference=-5.28%, 95% confidence interval [CI] -12.7% to -2.1%, p=0.040). High-dose corticosteroid decreased the non-recovery rate in severe Bell's palsy patients with a Yanagihara score of 0-10 (difference=-16.1%, 95% CI -38.5% to -6.2%, p=0.012), but did not decrease in moderate Bell's palsy patients with a Yanagihara score of 12-18 (difference=-2.0%, 95% CI -11.0% to 7.0%, p=0.591). Subgroup analysis revealed that the efficacy of high-dose corticosteroids was higher when patients were treated within 3days after disease onset, but not when patients were treated at 4days or later after disease onset.
Physicians would be better to treat severe Bell's palsy patients with high-dose corticosteroids when the patients are treated within 3days after disease onset.
本研究旨在评估高剂量皮质类固醇（相当于每日120mg泼尼松龙）与低剂量皮质类固醇（相当于60mg泼尼松龙）相比，治疗贝尔面瘫的有效性。
进行了一项单中心回顾性观察研究。纳入发病7天内接受治疗的成年贝尔面瘫患者。我们使用逆概率加权倾向评分分析（IPW-PS）比较高剂量和低剂量皮质类固醇在发病6个月时的未恢复率。
共纳入368例贝尔面瘫患者（高剂量组281例，低剂量组87例）。未进行IPW-PS时，低剂量组未恢复率为13.8%，高剂量组为8.2%。经IPW-PS调整后，低剂量组未恢复率为13.1%，高剂量组为7.8%（差异=-5.28%，95%置信区间[CI]-12.7%至-2.1%，p=0.040）。高剂量皮质类固醇降低了柳原评分0至10分的重度贝尔面瘫患者的未恢复率（差异=-16.1%，95%CI-38.5%至-6.2%，p=0.012），但未降低柳原评分12至18分的中度贝尔面瘫患者的未恢复率（差异=-2.0%，95%CI-11.0%至7.0%，p=0.591）。亚组分析显示，发病3天内接受治疗的患者，高剂量皮质类固醇的疗效更高，但发病4天及以后接受治疗的患者则不然。
对于重度贝尔面瘫患者，若在发病3天内接受治疗，医生最好使用高剂量皮质类固醇进行治疗。
