Shi Jianwei, Lu Dafeng, Chen Hairong, Shu Mingzhu, Xu Yang, Qian Jiaojiao, Ouyang Ke, Huang Huaying, Luo Zhengxiang, Wang Chunhui, Zhang Yansong
Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.
School of Public Health, Nanjing Medical University, Nanjing, China.
Front Neurol. 2022 Apr 18;13:868121. doi: 10.3389/fneur.2022.868121. eCollection 2022.
The objective was to comprehensively assess the efficacy and safety of all pharmacological and physical treatments (short-term, ≤ 1 month) for patients with acute Bell's palsy.
The electronic databases PubMed, Web of Science, Embase, Cochrane Library, and CNKI were searched for the randomized controlled trials comparing two or more regimens in patients with the Bell's palsy to be included in a Bayesian network meta-analysis. Odds ratios and CIs for the primary outcome of the House-Brackmann scale and secondary outcomes of sequelae (synkinesis and crocodile tears) and adverse events were obtained and subgroup analyses of steroids and antivirals were conducted.
A total of 26 studies representing 3,609 patients having undergone 15 treatments matched our eligibility criteria. For facial recovery, acupuncture plus electrical stimulation, steroid plus antiviral plus Kabat treatment, and steroid plus antiviral plus electrical stimulation were the top three options based on analysis of the treatment ranking (probability = 84, 80, and 77%, respectively). Steroid plus antiviral plus electrical stimulation had the lowest rate of sequelae but were more likely to lead to mild adverse events. Subgroup analysis revealed that methylprednisolone and acyclovir were likely to be the preferred option.
This network meta-analysis indicated that combined therapies, especially steroid plus antiviral plus Kabat treatment, were associated with a better facial function recovery outcome than single therapy. Other physical therapies, such as acupuncture plus electrical stimulation, may be a good alternative for people with systemic disease or allergies. More high-quality trials of physical regimens are needed in the future.
Our registered PROSPERO number is CRD42021275486 and detailed information can be found at https://www.crd.york.ac.uk/PROSPERO/.
全面评估所有药物和物理治疗（短期，≤1个月）对急性贝尔面瘫患者的疗效和安全性。
检索电子数据库PubMed、Web of Science、Embase、Cochrane图书馆和中国知网，查找比较贝尔面瘫患者两种或更多治疗方案的随机对照试验，纳入贝叶斯网络荟萃分析。获得House-Brackmann量表主要结局以及后遗症（联带运动和鳄鱼泪）和不良事件次要结局的比值比和置信区间，并进行类固醇和抗病毒药物的亚组分析。
共有26项研究（代表3609例接受了15种治疗的患者）符合我们的纳入标准。对于面部恢复，基于治疗排名分析，针灸加电刺激、类固醇加抗病毒药物加卡巴特疗法以及类固醇加抗病毒药物加电刺激是前三种选择（概率分别为84%、80%和77%）。类固醇加抗病毒药物加电刺激后遗症发生率最低，但更易导致轻度不良事件。亚组分析显示，甲基泼尼松龙和阿昔洛韦可能是首选药物。
这项网络荟萃分析表明，联合治疗，尤其是类固醇加抗病毒药物加卡巴特疗法，比单一疗法面部功能恢复效果更好。其他物理疗法，如针灸加电刺激，对于患有全身性疾病或过敏的患者可能是一个不错的选择。未来需要更多高质量的物理治疗方案试验。
我们在PROSPERO注册的编号是CRD42021275486，详细信息可在https://www.crd.york.ac.uk/PROSPERO/ 上查询。
