鼻内镜下手术与糖皮质激素药物治疗对外伤性视神经病变疗效比较的Meta分析  

Comparison between endoscopic surgery and glucocorticoid therapy for traumatic optic neuropathy:a meta-analysis

作　　者：余进海 吴艳 王耀华[1] 徐柒华[1] 熊超[1] 廖洪斐[1] Yu Jinhai;Wu Yan;Wang Yaohua;Xu Qihua;Xiong Chao;Liao Hongfei(Department of Orbital Disease Section,Affiliated Eye Hospital of Nanchang University,Jiangxi Clinical Research Center for Ophthalmic Disease,Jiangxi Research Institute of Ophthalmology and Visual Science,Nanchang 330006,China;Graduate School of Nanchang University,Nanchang 330031,China;Department of Ophthalmology,The Second People's Hospital of Jingdezhen,Jingdezhen 333000,China)

机构地区：[1]南昌大学附属眼科医院眼眶病科、江西省眼科疾病临床医学研究中心、江西省眼科学与视觉科学研究所,南昌330006 [2]南昌大学研究生院,南昌330031 [3]景德镇市第二人民医院眼科,景德镇333000

出　　处：《中华实验眼科杂志》2023年第1期42-46,共5页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金项目(82060181);江西省教育厅一般项目(GJJ210201)。

摘　　要：目的系统分析鼻内镜下经蝶筛入路减压手术治疗和糖皮质激素冲击治疗对外伤性视神经病变(TON)的疗效。方法检索PubMed、Web of Science、Cochrane Library、ClinicalTrial.gov、中国知网(CNKI)、万方以及中国生物医学等数据库从建库起至2020年11月1日发表的关于内镜手术和激素治疗TON的临床研究。由2名研究人员独立对文献进行筛选,并对纳入文献进行质量评价。以治疗前后视力是否提高作为有效判定指标。应用RevMan 5.3统计学软件进行Meta分析。采用排除文献法对结果进行敏感性分析。采用漏斗图和Begg检验对各研究的发表偏倚进行双重检验。结果纳入了8项研究,其中7项为队列研究,1项为随机对照试验。鼻内镜减压手术组与糖皮质激素药物组对TON治疗视力提高有效率无明显差异[比值比(OR)=1.65,95%置信区间(CI)∶0.75~3.66,P=0.22]。对于术前有残余视力的患者,鼻内镜减压手术组与糖皮质激素药物治疗组的治疗视力提高有效率也无明显差异(OR=2.17,95%CI:0.94~4.98,P=0.07)。对于鼻内镜减压手术治疗而言,早期(病程小于7 d)手术治疗比晚期(病程大于7 d)接受治疗的视力提高有效率更高(OR=4.73,95%CI:2.55~8.78,P<0.01)。敏感性分析提示此次文献分析结果稍欠稳键。Begg检验表明此次分析没有文献发表偏倚。结论鼻内镜手术与糖皮质激素药物治疗方式对TON的疗效没有显著差异,对于有残余视力的患者早期接受内镜手术治疗可能有助视力提高。Objective To systematically analyze the efficacy of nasal endoscopic transsphenoidal decompression and glucocorticoid pulse therapy for traumatic optic neuropathy(TON).Methods PubMed,Web of Science,Cochrane Library,ClinicalTrial.gov,CNKI,Wanfang,China Biomedical and other databases were searched to retrieve clinical studies on endoscopic surgery and hormone therapy for TON since their establishment to November 1,2020.Two researchers screened the literature and evaluated the quality of the included literatures.The improvement of visual acuity before and after treatment was taken as an effective indicator.RevMan 5.3 statistical software was used for meta-analysis.The sensitivity of the results was analyzed atfer literature exclusion.The publication bias of each study was double checked by funnel plot and Begg test.Results Eight studies were included,including 7 cohort studies and 1 randomized controlled trial.There was no significant difference between the endoscopic decompression group and glucocorticoid group in the efficiency of visual acuity improvement in the treatment of TON[odds ratio(OR)=1.65,95%confidence interval(CI)∶0.75-3.66,P=0.22],neither in TON patients with residual vision before surgery(OR=2.17,95%CI:0.94-4.98,P=0.07).For nasal endoscopic decompression surgery,early surgery(disease course<7 days)was more effective than late surgery(disease course>7 days)(OR=4.73,95%CI:2.55-8.78,P<0.01).Sensitivity analysis suggested that the results of this literature analysis were not robust.The Begg test showed that there was no literature publication bias.Conclusions There is no significant difference between nasal endoscopic surgery and glucocorticoid therapy in the treatment of TON.Early endoscopic surgery may help improve visual acuity in patients with residual vision.

关 键 词：内镜 外伤性视神经病变 激素治疗 疗效 

分 类 号：R779.6[医药卫生—眼科]