안면 마비(구안와사) 발생 원인과 경구용 약물요법 비교 평가 > 임상 응용 정보

안면 마비(구안와사) 발생 원인과 경구용 약물요법 비교 평가

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안면 마비 (구안와사)
 
      경구용 약물요법 비교 평가</TD></TR>
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안면 마비 (Bell’s Palsy)에 대한 경구용 약물 요법은
 
부신 피질 호르몬제와 항바이러스 약을 
 
동시에 투약하는 병용 처방이 가장 효과적임이 발표되었다
 
이는 캐나다 Toronto 의대 연구팀의 연구 분석 결과이며
 
미국 의사회지(JAMA)를 통해 발표된 것이다
 
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15개국 851개 임상 연구 분석 결과</TD></TR>
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본 연구는 전 세계 15개 국가에서 
 
2009년 3월까지 발표된
 
851개 임상 연구 내용을 분석(Meta analysis)한 것이다
 
이 중에서 임상 설계와 실시 방법이 충실한 
 
무작위 비교 임상 18건을 선정하여 
 
상호 비교 가능한 2,786명에 대하여 분석하였다 
 
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 처방 1 </TD>
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 성인 기준</TD>
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 치료 기간 </TD></TR>
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Prednisolone</TD>
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60mg/day </TD>
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처음 5일 </TD></TR>
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30mg/day</TD>
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30일</TD></TR>
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10mg/day</TD>
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2일 </TD></TR>
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Valcyclovir</TD>
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1000mg/day</TD>
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5일</TD></TR>
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 </TD></TR>
<TR style="HEIGHT: 14.25pt; mso-yfti-irow: 6">
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처방 2 </TD>
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<TR style="HEIGHT: 14.25pt; mso-yfti-irow: 7">
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Prednisolne</TD>
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1mg/kg/day</TD>
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12일</TD></TR>
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Acyclovir</TD>
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2400mg/day</TD>
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10일</TD></TR>
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 </TD></TR>
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처방 3</TD>
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<TR style="HEIGHT: 14.25pt; mso-yfti-irow: 11">
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Prednisolone</TD>
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60mg/day</TD>
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처음 10일</TD></TR>
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40mg/day</TD>
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2일</TD></TR>
<TR style="HEIGHT: 14.25pt; mso-yfti-irow: 13">
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30mg/day</TD>
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2일</TD></TR>
<TR style="HEIGHT: 14.25pt; mso-yfti-irow: 14">
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10mg/day</TD>
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1일</TD></TR>
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5mg/day</TD>
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2일 </TD></TR>
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 </TD></TR>
<TR style="HEIGHT: 15pt; mso-yfti-irow: 17">
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처방 4 </TD>
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<TD style="BORDER-BOTTOM: windowtext 1pt solid; BORDER-LEFT: #ffffff; PADDING-LEFT: 5.4pt; WIDTH: 103.8pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #ffcc99; HEIGHT: 15pt; BORDER-TOP: #ffffff; BORDER-RIGHT: windowtext 1pt solid" width=138></TD></TR>
<TR style="HEIGHT: 15pt; mso-yfti-irow: 18; mso-yfti-lastrow: yes">
<TD style="BORDER-BOTTOM: windowtext 1pt solid; BORDER-LEFT: windowtext 1pt solid; PADDING-LEFT: 5.4pt; WIDTH: 30.95pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #ccffff; HEIGHT: 15pt; BORDER-TOP: #ffffff; BORDER-RIGHT: windowtext 1pt solid" width=41></TD>
<TD style="BORDER-BOTTOM: windowtext 1pt solid; BORDER-LEFT: #ffffff; PADDING-LEFT: 5.4pt; WIDTH: 117.55pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #ffff99; HEIGHT: 15pt; BORDER-TOP: #ffffff; BORDER-RIGHT: windowtext 1pt solid" width=157 colSpan=2>
Dexamethasone</TD>
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0.13mg/kg/day</TD>
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61일 (7-240)</TD></TR></TBODY></TABLE>
  
부신 피질을 주 처방으로 하고
 
여기에 항 바이러스 약을 동시 병용 추가시키는 처방이
 
가장 효과가 높았다
 
다음은 부신 피질 단독 처방의 효과가 높았다
 
 
항 바이러스 약 단일 처방은 효과가 없었다</TD></TR>
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불만족 치료 율 비교 </TD></TR>
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<TD class=tbl-contents colSpan=2> 
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<TBODY>
<TR style="HEIGHT: 55.5pt; mso-yfti-irow: 0; mso-yfti-firstrow: yes">
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불만족 치료 율 비교 지수 비교\\
(수치 0 이하일수록 약효 크다) </TD></TR>
<TR style="HEIGHT: 48.75pt; mso-yfti-irow: 1">
<TD style="BORDER-BOTTOM: windowtext 1pt solid; BORDER-LEFT: windowtext 1pt solid; PADDING-LEFT: 5.4pt; WIDTH: 230.3pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #ffff99; HEIGHT: 48.75pt; BORDER-TOP: #ffffff; BORDER-RIGHT: windowtext 1pt solid" width=307>
 부신 피질 호르몬 
+ 항 바이러스 약 (동시 투약) </TD>
<TD style="BORDER-BOTTOM: windowtext 1pt solid; BORDER-LEFT: #ffffff; BACKGROUND-COLOR: transparent; PADDING-LEFT: 5.4pt; WIDTH: 14.2pt; PADDING-RIGHT: 5.4pt; HEIGHT: 48.75pt; BORDER-TOP: #ffffff; BORDER-RIGHT: windowtext 1pt solid" width=19>
 </TD>
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0.48</TD></TR>
<TR style="HEIGHT: 36.75pt; mso-yfti-irow: 2">
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 부신 피질 호르몬 단일 처방 </TD>
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 </TD>
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0.69</TD></TR>
<TR style="HEIGHT: 37.5pt; mso-yfti-irow: 3; mso-yfti-lastrow: yes">
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 항 바이러스 약 단일 처방 </TD>
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1.14 (효과 없음)</TD></TR></TBODY></TABLE> </TD></TR>
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동시 투약 법이 더 우수 하다 </TD></TR>
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병용 처방의 경우 부신 피질 호르몬 제와 항 바이러스 약은 
 
동시 투약을 하는 것이 더 효과가 우수하다
 
항 바이러스 약을 먼저 투약한 후 
 
부신 피질 호르몬 제를 뒤따라 투약하는 것은 효과가 덜하다</TD></TR>
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발병 후 투약 시간의 차이 </TD></TR>
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안면마비 발생 72 시간 내 투약을 시작하는 경우와
 
72시간 지나서 투약을 시작하는 경우 약물 치료 효과 차이는 없다</TD></TR>
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얼굴이 찌그러지는 안면 마비란 </TD></TR>
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<IMG src="/_dimg/4입ㅈ%20비틀.bmp">
 
 
<IMG src="/_dimg/5%20안며누%20ㅅㄴ경.bmp">
 
안면 마비라 함은 
 
귀 속 내이 부분에서 얼굴로 분포되는 
 
다섯 가닥의 안면 신경이 부종을 일으키는 병이다
 
턱, 입술, 코 언저리, 눈 등의 근육의 동작이 
 
방향성을 잃고 비틀어지는 증상을 나타낸다
 
 
방향성을 잃고 비틀어지는 증상을 나타낸다
 
<IMG src="/_dimg/6%20%20말포%20신경.bmp">
[그림] 안면 신경(facials nerve)은 뇌신경(7차 신경)이지만 
          중추 신경이 아니고 말초 신경이다</TD></TR>
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두 종류의 바이러스가 일으킨다</TD></TR>
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안면 마비의 2/3은 수포 바이러스인 Herpes simplex가 일으킨다
 
안면 마비의 1/3은 수두 바이러스 Varicella Zoster가 일으킨다
 
이 바이러스들이 안면 신경에서 증식하면서
 
신경을 부어 오르게 한다
 
Varicella Zoster 인 경우는 Herpes simplex보다 
 
항 바이러스 약을 더 고량 높여 
 
부신 피질 호르몬 제와 병용 처방해야 한다</TD></TR>
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사람마다 치료 경과가 다르다 </TD></TR>
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안면 마비는 치료를 하지 않아도 71%의 환자는 자연히 치료된다
 
 13%는 치료하면 완치된다
 
 16%는 경증 상태 또는 중증 상태로서 오래 치료해야 한다</TD></TR>
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초기 증상이 심하면</TD></TR>
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초기 증상이 심한 자 즉 많이 비틀어져 있는 자라 할지라도
 
치료하면 61%는 곧 완치된다
 
33%는 불완전하게 치료된다
 
통상 치료 기간은 4개월 정도이다</TD></TR>
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부신 피질 호르몬 제는 
 
어떻게 안면마비를 치료하나</TD></TR>
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부신 피질 호르몬 제는 항암 작용을 발휘하여 
신경 부종을 정상화 시킨다
 
또한 면역 계로 하여금 항 바이러스 작용을 발휘한다
 
부신 피질 호르몬 요법은 고용 량 일수록 효과가 더 좋다</TD></TR>
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근거
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JAMA. 2009;302(9):985-993. 
Combined Corticosteroid and Antiviral Treatment for Bell Palsy 
A Systematic Review and Meta-analysis
 
<A href="http://jama.ama-assn.org/cgi/content/full/302/9/985#AUTHINFO#AUTHINFO">John R. de Almeida, MD; Murtadha Al Khabori, MD; Gordon H. Guyatt, MD, MSc, FRCPC; Ian J. Witterick, MD, MSc, FRCSC; Vincent Y. W. Lin, MD, FRCSC; Julian M. Nedzelski, MD, FRCSC; Joseph M. Chen, MD, FRCSC </A></TD></TR></TBODY></TABLE>
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