目的：评价泼尼松龙和泼尼松龙联合伐昔洛韦在不同程度Bell’s面瘫患者中的疗效。方法将2010年1月-2013年1月于我院门诊就诊280例Bell’s面瘫患者（年龄18-75岁、面瘫起病72小时内的患者）随机分为两组：泼尼松龙组（140人），联合治疗组（140人），分别给予泼尼松龙单药、泼尼松龙+伐昔洛韦治疗。随访持续12个月,254例患者完成了12个月的随访。根据Sunnybrook评分系统评价起病及12个月时的面神经功能。完全恢复为Sunnybrook评分100分。结果在重度面瘫患者中，12月内痊愈率分别为52%（泼尼松龙治疗组）和53.8%（联合治疗组）（P>0.05）；中度面瘫患者痊愈率分别为69.8%和68.3%（P>0.05），轻度面瘫患者痊愈率分别为83.3%和84.7%（P>0.05）。12个月时，在重度面瘫患者中，连带运动出现比列分别为40%（泼尼松龙治疗组）和42.3%（联合治疗组）（P>0.05）；中度面瘫患者连带运动比例分别为23.3%和22%（P>0.05），轻度面瘫患者连带运动比列分别为5%和5.1%（P>0.05）。结论无论Bell’s面瘫起病程度如何，与单独使用泼尼松龙相比，泼尼松龙联合伐昔洛韦治疗并未增加面瘫痊愈率，也未减少连带运动比例。因此，在Bell’s面瘫患者的治疗中，不推荐泼尼松龙联合伐昔洛韦治疗。%Objectives To compare the efficacy of prednisolone and prednisolone combined with valaci-clovir in treating Bell’s palsy. Methods Patients (n=280) seen in our outpatient clinic between January 2010 and January 2013 (aged 18–75 years and treated within 72 h of palsy onset) were divided randomly to receive prednisolone alone (n=140) or prednisolone combined with valacyclovir (n=140). Of them, 254 patients com-pleted a 12-month follow-up. Facial nerve function was assessed using the Sunnybrook grading scale at base-line and at12 months. Complete recovery was defined as Sunnybrook score=100. Results In patients with se-vere palsy, the rate of recovery at 12 months was 52%with prednisolone treatment versus 53.8%with the com-bined treatment (P>0.05). The rate was 69.8% versus 68.3% (P>0.05) for patients with moderate palsy, and 83.3%versus 84.7%(P>0.05) for those with mild palsy. For patients with severe palsy at baseline, the rate of synkinesis at 12 months was 40%in the prednisolone group and 42.3%in the combined treatment group, re-spectively, for patients with severe palsy (P>0.05); 23.3% and 22%, respectively, for patients with moderate palsy (P>0.05);and 5%and 5.1%, respectively, for those with mild palsy (P>0.05). Conclusions Compared to prednisolone treatment alone, combined treatment with prednisolone and valaciclovir does not appear to in-crease recovery of palsy or to reduce the rate of synkinesis regardless of palsy severity at baseline.
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