婴幼儿口服普萘洛尔治疗血管瘤的适宜月龄探讨
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摘要
目的探讨婴幼儿口服普萘洛尔治疗血管瘤的适宜月龄。方法选取接受口服普萘洛尔治疗(每日1.5mg/kg,分2次口服)的39例婴幼儿血管瘤患者,按月龄分成两组,≤3月龄为A组(20例),>3月龄为B组(19例)。比较两组患儿一般情况、治疗效果、服药时间、不良反应发生率及复发情况。结果两组患儿性别、年龄、出生史、瘤体部位(其中1例患儿四肢血管瘤合并肝脏血管瘤)、瘤体分型比较,差异均无统计学意义(均P>0.05)。A组患儿治愈率为72.2%,明显高于B组的35.3%(P<0.05);两组患儿有效率、服药时间、不良反应发生率比较,差异均无统计学意义(均P>0.05)。A组1例患儿停药后复发,予外敷噻吗洛尔滴眼液2个月后消退;B组无复发病例。结论 3月龄前口服普萘洛尔治疗婴幼儿血管瘤的治愈率更高,近期不良反应未增加。
Objective To explore the appropriate age of infants for the treatment of hemangioma with oral propranolol.Methods Thirty-nine infants with hemangioma receiving oral propranolol [(1.5 mg/(kg·d),bid ] for treatment,including 20 cases aged ≤3 months(group A) and 19 cases aged >3 months(group B).The demographic characteristics,treatment effect,duration of therapy,incidence of adverse reactions and recurrence were compared between the two groups.Results There were no significant differences in gender,age,birth history,tumor site and tumor type between the two groups(all P >0.05).The cure rate of group A was significantly higher than that of group B(72.2% vs 35.3%,P <0.05).The effective rate,duration of treatment and the incidence of adverse reactions were not significantly different between the two groups(all P >0.05).One patient in group A relapsed after discontinuation of propranolol and the symptoms were improved after local application of tiamolol eye drops for two months.No recurrence was found in group B.Conclusion Oral propranolol administration before 3 months of age has a higher cure rate in infantile hemangiomas without increase of adverse reactions.
Objective To explore the appropriate age of infants for the treatment of hemangioma with oral propranolol.Methods Thirty-nine infants with hemangioma receiving oral propranolol [(1.5 mg/(kg·d),bid ] for treatment,including 20 cases aged ≤3 months(group A) and 19 cases aged >3 months(group B).The demographic characteristics,treatment effect,duration of therapy,incidence of adverse reactions and recurrence were compared between the two groups.Results There were no significant differences in gender,age,birth history,tumor site and tumor type between the two groups(all P >0.05).The cure rate of group A was significantly higher than that of group B(72.2% vs 35.3%,P <0.05).The effective rate,duration of treatment and the incidence of adverse reactions were not significantly different between the two groups(all P >0.05).One patient in group A relapsed after discontinuation of propranolol and the symptoms were improved after local application of tiamolol eye drops for two months.No recurrence was found in group B.Conclusion Oral propranolol administration before 3 months of age has a higher cure rate in infantile hemangiomas without increase of adverse reactions.
引文
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[12]Chang LC,Haggstrom AN,Drolet BA,et al.Growth characteristics of infantile hemangiomas:implications for management[J].Pediatrics,2008,122(2):360-367.DOI:10.1542/peds.2007-2767.
[13]L aute-Labr ze C,Hoeger P,Mazereeuw-haytierJ,et al.A randomized,controlled trial of oral propranolol in infantile hemangioma[J].N Engl JMed,2015,372(8):735-746.DOI:10.1056/NEJMoa1404710.
[14]L aute-Labr ze C,Boccara O,Degrugilier-choinet C,et al.Safety of O-ral Propranolol for the Treatment of Infantile Hemangioma:A Systematic Review[J].Pediatrics,2016,138(4):e20160353.DOI:10.1542/peds.2016-0353.
[15]Kim KH,Choi TH,Choi Y,et al.Comparison of Efficacy and Safety Between Propranolol and Steroid for Infantile Hemangioma:A Randomized Clinical Trial[J].JAMADermatol,2017,153(6):529-536.DOI:10.1001/jamadermatol.2017.0250.
[16]黄长瑾,宋维铭.普萘洛尔治疗婴幼儿血管瘤的研究进展[J].中国美容整形外科杂志,2017,28(12):768,插1-3.DOI:10.3969/j.issn.1673-7040.2017.12.022.
[17]Ei HM,Gesualdo F,Diociaiuti A,et al.Safety and effectiveness of oral propranolol for infantile hemangiomas started before 5 weeks and after5 months of age:an Italian multicenter experience[J].Ital J Pediatr,2017,43(1):40.DOI:10.1186/s13052-017-0357-9.
[18]Tang LY,Hing JW,Tang JY,et al.Predicting complications with pretreatment testing in infantile haemangioma treated with oral propranolol[J].Br J Ophthalmol,2016,100(7):902-906.DOI:10.1136/bjophthalmol-2015-307284.
[19]Petrovic J,Trifunovic B,Vukomanovic G,et al.Oral propranolol for infantile hemangiomas:a prospective study on the role of 48-hour Holter monitoring in additional safety assessment[J].J Dermatolog Treat,2017,28(6):554-558.DOI:10.1080/09546634.2016.1277177.
[20]Ji Y,Chen S,Wang Q,et al.Intolerable side effects during propranolol therapy for infantile hemangioma:frequency,risk factors and management[J].Sci Rep,2018,8(1):4264.DOI:10.1038/s41598-018-22787-8.
[21]Shah SD,Baselga E,Mccuaig C,et al.Rebound Growth of Infantile Hemangiomas After Propranolol Therapy[J].Pediatrics,2016,137(4):e20153739.DOI:10.1542/peds.2015-1754.
[22]Chang L,Gu Y,Yu Z,et al.When to stop propranolol for infantile hemangioma[J].SciRep,2017,7:43292.DOI:10.1038/srep43292.
[2]Janmoham SR,Madern GC,Delatt PC,et al.Educational paper:therapy of infantile haemangioma--history and current state(part II)[J].Eur JPediatr,2015,174(2):259-266.DOI:10.1007/s00431-014-2404-5.
[3]L aut-Labr ze C,Delaroque ED,Hubiche T,et al.Propranolol for severe hemangiomas of infancy[J].N Engl J Med,2008,358(24):2649-2651.DOI:10.1056/NEJMc0708819.
[4]Schiestl C,Neuhaus K,Zoller S,et al.Efficacy and safety of propranolol as first-line treatment for infantile hemangiomas[J].Eur J Pediatr,2011,170(4):493-501.DOI:10.1007/s00431-010-1324-2.
[5]Levitt M,Coumou AD,Groeneveld L,et al.Propranolol as first-line treatment in orbital infantile haemangiomas:a case series[J].Orbit,2014,33(3):178-183.DOI:10.3109/01676830.2014.884148.
[6]Yun YJ,Gyon YH,Yang S,et al.A prospective study to assess the efficacy and safety of oral propranolol as first-line treatment for infantile superficial hemangioma[J].Korean J Pediatr,2015,58(12):484-490.DOI:10.3345/kjp.2015.58.12.484.
[7]Solman L,Glover M,Beattie PE,et al.Oral propranolol in the treatment of proliferating infantile haemangiomas:the British Society for Paediatric Dermatology consensus guidelines[J].Br J Dermatol,2018.DOI:https://doi.org/10.1111/bjd.16779.[Epub ahead of print]
[8]郑家伟,王绪凯,秦中平,等.口服普萘洛尔治疗婴幼儿血管瘤中国专家共识[J].上海口腔医学,2016,25(3):257-260.
[9]Hoeger PH,Happer JI,Baselgas E,et al.Treatment of infantile haemangiomas:recommendations of a European expert group[J].Eur J Pediatr,2015,174(7):855-865.DOI:10.1007/s00431-015-2570-0.
[10]Achauer BM,Chang CJ,Vander KVM.Management of hemangioma of infancy:review of 245 patients[J].Plast Reconstr Surg,1997,99(5):1301-1308.
[11]L aute-Labr ze C,Harper JI,Hoeger PH.Infantile haemangioma[J].Lancet,2017,390(10089):85-94.DOI:10.1016/S0140-6736(16)00645-0.
[12]Chang LC,Haggstrom AN,Drolet BA,et al.Growth characteristics of infantile hemangiomas:implications for management[J].Pediatrics,2008,122(2):360-367.DOI:10.1542/peds.2007-2767.
[13]L aute-Labr ze C,Hoeger P,Mazereeuw-haytierJ,et al.A randomized,controlled trial of oral propranolol in infantile hemangioma[J].N Engl JMed,2015,372(8):735-746.DOI:10.1056/NEJMoa1404710.
[14]L aute-Labr ze C,Boccara O,Degrugilier-choinet C,et al.Safety of O-ral Propranolol for the Treatment of Infantile Hemangioma:A Systematic Review[J].Pediatrics,2016,138(4):e20160353.DOI:10.1542/peds.2016-0353.
[15]Kim KH,Choi TH,Choi Y,et al.Comparison of Efficacy and Safety Between Propranolol and Steroid for Infantile Hemangioma:A Randomized Clinical Trial[J].JAMADermatol,2017,153(6):529-536.DOI:10.1001/jamadermatol.2017.0250.
[16]黄长瑾,宋维铭.普萘洛尔治疗婴幼儿血管瘤的研究进展[J].中国美容整形外科杂志,2017,28(12):768,插1-3.DOI:10.3969/j.issn.1673-7040.2017.12.022.
[17]Ei HM,Gesualdo F,Diociaiuti A,et al.Safety and effectiveness of oral propranolol for infantile hemangiomas started before 5 weeks and after5 months of age:an Italian multicenter experience[J].Ital J Pediatr,2017,43(1):40.DOI:10.1186/s13052-017-0357-9.
[18]Tang LY,Hing JW,Tang JY,et al.Predicting complications with pretreatment testing in infantile haemangioma treated with oral propranolol[J].Br J Ophthalmol,2016,100(7):902-906.DOI:10.1136/bjophthalmol-2015-307284.
[19]Petrovic J,Trifunovic B,Vukomanovic G,et al.Oral propranolol for infantile hemangiomas:a prospective study on the role of 48-hour Holter monitoring in additional safety assessment[J].J Dermatolog Treat,2017,28(6):554-558.DOI:10.1080/09546634.2016.1277177.
[20]Ji Y,Chen S,Wang Q,et al.Intolerable side effects during propranolol therapy for infantile hemangioma:frequency,risk factors and management[J].Sci Rep,2018,8(1):4264.DOI:10.1038/s41598-018-22787-8.
[21]Shah SD,Baselga E,Mccuaig C,et al.Rebound Growth of Infantile Hemangiomas After Propranolol Therapy[J].Pediatrics,2016,137(4):e20153739.DOI:10.1542/peds.2015-1754.
[22]Chang L,Gu Y,Yu Z,et al.When to stop propranolol for infantile hemangioma[J].SciRep,2017,7:43292.DOI:10.1038/srep43292.