复发性面神经炎52例临床分析
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摘要
目的总结复发性面神经炎的发病特点及治疗方案。方法回顾性分析郑州人民医院神经内科2012-05—2016-05收治的52例复发性面神经炎患者的发病特点、临床表现、磁共振检查、脑脊液及自身免疫抗体检测结果。根据患者意愿分为2组,观察组30例给予甲强龙500mg,连用3d冲击治疗,10d内阶梯减量至停用;对照组22例给予强的松30mg,连用1周后,10d内减量停用。2组均给予阿昔洛韦0.4g/次,3次/d,连用10d,以及B族维生素、理疗针灸等对症支持治疗。结果根据House-Brackmann面瘫评定标准,治疗后2组功能改善均较治疗前提高,观察组治愈率显著高于对照组,差异有统计学意义(P<0.05)。结论复发性面神经炎病因复杂、诊断缺乏特异性,早期诊断及合理治疗对预后至关重要。
Objective We summarize and analyze the clinical characteristics and treatments about recurrent facial paralysis,in order to provide the basises for clinic.Methods We retrospectively analyzed the clinical characteristics,magnetic resonance imaging(MRI),cerebrospinal fluid and autoimmune antibody test results about 52 patients with recurrent facial paralysis in Zhengzhou People's Hospital from May 2012 to May 2016.They were divided into two groups according to their wishes.In the observation group,30 patients were treated with a dose of methylprednisolone 500 mg for 3 days,and then gradually reduced within10 days.In the control group,there were 22 patients were treated with prednisolone 30 mg for 1 week,and gradually reduced within 10 days.All of them were received comprehensive treatments,such as vitamins B,physiotherapy,acupuncture and so on.Results According to the House-Brackmann's facial paralysis assessment criteria,the functional improvement of the two groups was better than that before treatment,the cure rate in the observation group was higher than that of control group,the difference was statistically significant(P<0.05).Conclusion The etiology of patients with recurrent facial paralysis was complexed and the diagnosis was lack of specificity,so earlier diagnosis and treatment were very important for the prognosis of patients.
Objective We summarize and analyze the clinical characteristics and treatments about recurrent facial paralysis,in order to provide the basises for clinic.Methods We retrospectively analyzed the clinical characteristics,magnetic resonance imaging(MRI),cerebrospinal fluid and autoimmune antibody test results about 52 patients with recurrent facial paralysis in Zhengzhou People's Hospital from May 2012 to May 2016.They were divided into two groups according to their wishes.In the observation group,30 patients were treated with a dose of methylprednisolone 500 mg for 3 days,and then gradually reduced within10 days.In the control group,there were 22 patients were treated with prednisolone 30 mg for 1 week,and gradually reduced within 10 days.All of them were received comprehensive treatments,such as vitamins B,physiotherapy,acupuncture and so on.Results According to the House-Brackmann's facial paralysis assessment criteria,the functional improvement of the two groups was better than that before treatment,the cure rate in the observation group was higher than that of control group,the difference was statistically significant(P<0.05).Conclusion The etiology of patients with recurrent facial paralysis was complexed and the diagnosis was lack of specificity,so earlier diagnosis and treatment were very important for the prognosis of patients.
引文
[1]贾建平,陈生弟.特发性面神经麻痹[M]//神经病学.7版.北京:人民卫生出版社,2013:339-340.
[2]CIRPACIU D,GOANTA C M,CIRPACIU M D.Recurrences of Bell's palsy.Recurrences of Bell's palsy[J].J Med Life,2014,7(Speclss 3):68-77.
[3]刘明生,卜碧涛,陈琳,等.中国特发性面神经麻痹诊治指南[J].中华神经科杂志,2016,49(2):84-86.
[4]HOUSE J W,BRACKMANN D E.Facial nerve grading system[J].Otolaryngol Head Neck Surg,1985,93(2):146-147.
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[6]KATZ A,SERGIENKO R,DIOR U,et al.Bell’s palsy during pregnancy:is it associated with adverse perinatal outcome[J].Laryngoscope,2011,121(7):1 395-1 398.
[7]PEITERSEN E.Bell’s palsy:the spontaneous course of2500peripheral facial nerve palsies of different etiologies[J].Acta Otolaryngol Suppl,2002,549:4-30.
[8]李德华,杨玲,李季.从贝尔麻痹的预后判定谈面神经炎的管理[J].中华神经医学杂志,2016,15(6):644-648.
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[10]MC CAUL J A,CASCARINI L,GODDEN D,et al.Evidence based management of Bell's palsy[J].Br J Oral Maxillofac Surg,2014,52(5):387-391.
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[13]DE DIEGO-SASTRE J I,PRIM-ESPADA M P,FERNNDEZ-GARCíA F.The epidemiology of Bell's palsy[J].Rev Neurol,2005,41(5):287-290.
[14]SWAMI H,DUTTA A,NAMBIAR S.Recurrent Bell's Palsy[J].Med J Armed Forces India,2010,66(1):95-96.
[15]CHUNG D H,PARK D C,BYUN J Y,et a1.Prognosis of patients with recurrent facial palsy[J].Eur Arch Otorhinolaryngo,2012,269(1):61-66.
[16]DO K.Bell’s plalsy[J].Med J,2002,3(2):509-521.
[17]YURRITA B S,CALVO C R,PLIEGO E S.Idiopathic recurrent facial palsy[J].Acta Otorrinolaringol Esp,2004,55:343-345.
[18]NAVARRETE M L,CESPEDES R,MESA M.Paralisis facial de Bell recurrente:nuestra experiencia[J].Acta Otorrinlaringol Esp,2001,52:682-686.
[19]OKUDO J,OLUYIDE Y.Melkersson-Rosenthal Syndrome with Orofacial Swelling and Recurrent Lower Motor Neuron Facial Nerve Palsy:A Case Report and Review of the Literature[J].Otolaryngol,2015,10:1 155.
[20]DESAI S D,DUMRALIYA P,MEHTA D.MelkerssonRosenthal syndrome[J].J Neurosci Rural Pract,2014,5(5):S112-S114.
[21]CHATZISTEFANOU I,ZIKOS P,VENETIS G,et al.Melkersson-Rosenthal syndrome[J].World J Stomatol,2015,4(1):8-11.
[22]BIRNBAUM J.Facial Weakness,Otalgia,and Hemifacial Spasm:A Novel Neurological Syndrome in a CaseSeries of 3 Patients With Rheumatic Diseas[J].Medicine(Baltimore),2015,94(40):e1445.
[23]GILCHRIST J M.Seventh cranial neuropathy[J].Semin Neurol,2009,29:5-13.
[24]FERRER I.Pathology of paraneoplastic syndromes of the central and peripheral nervous systems and muscle[J].Rev Neurol,2000,31(12):1 228-1 236.
[25]CROFT P B,WILKINSON M.The incidence of carcinomatous neuromyopathy in patients with various types of carcinoma[J].Brain,1996,88:427-434.
[26]PECKET P,SCHATTNER A.Concurrent Bell's palsy and diabetes mellitus:a diabetic mononeuropathy?[J].J Neurol Neurosurg Psychiatry,1982,45(7):652-655.
[27]HAMPTON A L,COLBY L A,BERGIN I L,et al.Facial Paralysis and Lymphocytic Facial Neuritis in a Rhesus Macaque(Macaca mulatta)Positive for Simian Retrovirus Type D2[J].Comp Med,2011,61(6):538-545.
[28]周熙,田丰玮,毛翔,等.管灸联合常规针刺治疗急性面神经炎临床研究[J].中国中医药信息杂志,2018,25(3):38-41.
[29]付光斌,翟华.复方甘草酸苷注射液治疗面神经炎的瞬目反射评价[J].中国实用神经疾病杂志,2018,21(5):496-498.
[30]王祖红,郭春艳,黄培冬,等.运动针法治疗急性面神经炎疗效观察[J].上海针灸杂志,2018,37(2):205-208.
[31]冯建玉,李晓青.中频脉冲电治疗重度面神经炎的临床观察[J].检验医学与临床,2017,14(Z1):298-299.
[32]秦国英,常胜利,王亚青,等.综合疗法治疗复发性面神经炎4例[J].中国实用神经疾病杂志,2013,5(16):55-57.
[33]BAUGH R F,BASURA G J,ISHII L E,et al.Clinical practice guideline Bell’s palsy[J].Otolaryngol Head Neck Surg,2013,149(3suppl):S1-S27.
[34]ENGSTROM M,BERG T,STJEMQUIST-DESATNIK A,et al.Prednisolone and valaciclovir in Bell’s palsy:a randomized,double-blind,placebo-controlled,multicentre trial[J].Lancet Neurol,2008,7(11):993-1 000.
[35]GAGYOR I,MADHOK V B,DALY F,et al.Antiviral treatment for Bell’s palsy(idiopathic facial paralysis)[J].Cochrane Database Syst Rev,2015,11:CD001869.
[2]CIRPACIU D,GOANTA C M,CIRPACIU M D.Recurrences of Bell's palsy.Recurrences of Bell's palsy[J].J Med Life,2014,7(Speclss 3):68-77.
[3]刘明生,卜碧涛,陈琳,等.中国特发性面神经麻痹诊治指南[J].中华神经科杂志,2016,49(2):84-86.
[4]HOUSE J W,BRACKMANN D E.Facial nerve grading system[J].Otolaryngol Head Neck Surg,1985,93(2):146-147.
[5]TIEMSTRA J D,KHATKHATE N.Bell’s palsy:diagnosis and management[J].Am Fain Physician,2007,76(7):997-1 002.
[6]KATZ A,SERGIENKO R,DIOR U,et al.Bell’s palsy during pregnancy:is it associated with adverse perinatal outcome[J].Laryngoscope,2011,121(7):1 395-1 398.
[7]PEITERSEN E.Bell’s palsy:the spontaneous course of2500peripheral facial nerve palsies of different etiologies[J].Acta Otolaryngol Suppl,2002,549:4-30.
[8]李德华,杨玲,李季.从贝尔麻痹的预后判定谈面神经炎的管理[J].中华神经医学杂志,2016,15(6):644-648.
[9]吴俊,周贤刚,钟渠.面神经炎后遗症危险因素的Logistic回归分析[J].中华神经内科杂志,2007,40(2):109-111.
[10]MC CAUL J A,CASCARINI L,GODDEN D,et al.Evidence based management of Bell's palsy[J].Br J Oral Maxillofac Surg,2014,52(5):387-391.
[11]GLASS G E,TZAFETTA K.Bell's palsy:a summary of current evidence and referral algorithm[J].Fam Pract,2014Sep 10,pii:cmu058.
[12]NAVARRETE M L,CSPEDES R,MESA M,et al.Recurrent Bell's facial palsy:our experience[J].Acta Otorrinolaringologica Espanola,2001,52(8):682-686.
[13]DE DIEGO-SASTRE J I,PRIM-ESPADA M P,FERNNDEZ-GARCíA F.The epidemiology of Bell's palsy[J].Rev Neurol,2005,41(5):287-290.
[14]SWAMI H,DUTTA A,NAMBIAR S.Recurrent Bell's Palsy[J].Med J Armed Forces India,2010,66(1):95-96.
[15]CHUNG D H,PARK D C,BYUN J Y,et a1.Prognosis of patients with recurrent facial palsy[J].Eur Arch Otorhinolaryngo,2012,269(1):61-66.
[16]DO K.Bell’s plalsy[J].Med J,2002,3(2):509-521.
[17]YURRITA B S,CALVO C R,PLIEGO E S.Idiopathic recurrent facial palsy[J].Acta Otorrinolaringol Esp,2004,55:343-345.
[18]NAVARRETE M L,CESPEDES R,MESA M.Paralisis facial de Bell recurrente:nuestra experiencia[J].Acta Otorrinlaringol Esp,2001,52:682-686.
[19]OKUDO J,OLUYIDE Y.Melkersson-Rosenthal Syndrome with Orofacial Swelling and Recurrent Lower Motor Neuron Facial Nerve Palsy:A Case Report and Review of the Literature[J].Otolaryngol,2015,10:1 155.
[20]DESAI S D,DUMRALIYA P,MEHTA D.MelkerssonRosenthal syndrome[J].J Neurosci Rural Pract,2014,5(5):S112-S114.
[21]CHATZISTEFANOU I,ZIKOS P,VENETIS G,et al.Melkersson-Rosenthal syndrome[J].World J Stomatol,2015,4(1):8-11.
[22]BIRNBAUM J.Facial Weakness,Otalgia,and Hemifacial Spasm:A Novel Neurological Syndrome in a CaseSeries of 3 Patients With Rheumatic Diseas[J].Medicine(Baltimore),2015,94(40):e1445.
[23]GILCHRIST J M.Seventh cranial neuropathy[J].Semin Neurol,2009,29:5-13.
[24]FERRER I.Pathology of paraneoplastic syndromes of the central and peripheral nervous systems and muscle[J].Rev Neurol,2000,31(12):1 228-1 236.
[25]CROFT P B,WILKINSON M.The incidence of carcinomatous neuromyopathy in patients with various types of carcinoma[J].Brain,1996,88:427-434.
[26]PECKET P,SCHATTNER A.Concurrent Bell's palsy and diabetes mellitus:a diabetic mononeuropathy?[J].J Neurol Neurosurg Psychiatry,1982,45(7):652-655.
[27]HAMPTON A L,COLBY L A,BERGIN I L,et al.Facial Paralysis and Lymphocytic Facial Neuritis in a Rhesus Macaque(Macaca mulatta)Positive for Simian Retrovirus Type D2[J].Comp Med,2011,61(6):538-545.
[28]周熙,田丰玮,毛翔,等.管灸联合常规针刺治疗急性面神经炎临床研究[J].中国中医药信息杂志,2018,25(3):38-41.
[29]付光斌,翟华.复方甘草酸苷注射液治疗面神经炎的瞬目反射评价[J].中国实用神经疾病杂志,2018,21(5):496-498.
[30]王祖红,郭春艳,黄培冬,等.运动针法治疗急性面神经炎疗效观察[J].上海针灸杂志,2018,37(2):205-208.
[31]冯建玉,李晓青.中频脉冲电治疗重度面神经炎的临床观察[J].检验医学与临床,2017,14(Z1):298-299.
[32]秦国英,常胜利,王亚青,等.综合疗法治疗复发性面神经炎4例[J].中国实用神经疾病杂志,2013,5(16):55-57.
[33]BAUGH R F,BASURA G J,ISHII L E,et al.Clinical practice guideline Bell’s palsy[J].Otolaryngol Head Neck Surg,2013,149(3suppl):S1-S27.
[34]ENGSTROM M,BERG T,STJEMQUIST-DESATNIK A,et al.Prednisolone and valaciclovir in Bell’s palsy:a randomized,double-blind,placebo-controlled,multicentre trial[J].Lancet Neurol,2008,7(11):993-1 000.
[35]GAGYOR I,MADHOK V B,DALY F,et al.Antiviral treatment for Bell’s palsy(idiopathic facial paralysis)[J].Cochrane Database Syst Rev,2015,11:CD001869.