不同β受体阻滞剂治疗婴幼儿血管瘤的疗效观察

Clinical efficacies of different types of β receptor blockers for infantile hemangioma

目的分析不同β受体阻滞剂治疗婴幼儿血管瘤的临床疗效和并发症,观察治疗期间药物对生长发育的影响。方法本研究为前瞻性研究,选取2017年1月至2022年5月福建医科大学附属福州儿童医院烧伤整形科采用口服β受体阻滞剂治疗的33例婴幼儿血管瘤病例作为研究对象,其中男14例,女19例。按照患儿家属意愿分为普萘洛尔组(22例)和阿替洛尔组(11例),普萘洛尔组予口服非选择性β受体阻滞剂(普萘洛尔),剂量为1.5~2 mg·kg^(-1)·d^(-1)。阿替洛尔组予口服选择性β受体阻滞剂(阿替洛尔),剂量为第1周0.5 mg·kg^(-1)·d^(-1),之后改为1 mg·kg^(-1)·d^(-1)。两组均每月复查1次,观察瘤体颜色、大小、质地等变化及并发症情况;分别于用药后1个月、5~6个月、10~12个月通过彩超测量瘤体体积,并进行生长发育评估。结果两组患儿首诊年龄、性别、部位、类型等差异无统计学意义(P>0.05)。两组患儿治疗有效率均为100%。两组用药后1个月、5~6个月、10~12个月瘤体体积缩小差异无统计学意义(P>0.05)。不良反应:普萘洛尔组有5例(5/22)出现呼吸道症状、烦躁或睡眠障碍;阿替洛尔洛尔组有2例(2/11)出现烦躁或睡眠障碍;两组均无一例严重不良反应,生长发育均未发现异常,用药后1、3、6、9个月发育商比较,差异亦无统计学意义(P>0.05)。结论β受体阻滞剂普萘洛尔与阿替洛尔治疗婴幼儿血管瘤疗效相当,对患儿生长发育均无影响。考虑普萘洛尔对呼吸道有不良影响,阿替洛尔可作为普萘洛尔的替代药物用于治疗婴幼儿血管瘤。

Objective To observe the clinical efficacy and complications ofβreceptor blockers for infantile hemangioma(IH)and observe the effect on growth and development during treatment.Methods From January 2017 to may 2022,33 IH children were recruited.They were randomized into two groups of propranolol(n=22)and atenolol(n=11)according to parental wishes.No significant inter-group differences existed in age,gender,location or type(P>0.05).The former group received an oral dose of non-selective propranolol 1.5-2 mg·kg^(-1)·d^(-1).And the latter group was prescribed with atenolol at 0.5 mg·kg^(-1)·d^(-1)in the first week and then 1 mg·kg^(-1)·d^(-1).During monthly follow-ups,the changes of clinical manifestations such as tumor color,size,texture and the complications were recorded.Color Doppler ultrasound was performed for measuring tumor volume and evaluating growth and development.Results There was nostatistically significant difference in the age,gender,Location,and type of initial diagnosis between the two groups of chidren(P>0.05).The effective rate of both groups was 100%.No statistically significant reduction occurred in tumor volume in neither groups at Month 1,5-6 and 10-12 post-treatment(P>0.05).Adverse reactions of drug dosing occurred in propranolol group(5/22,22.7%)with respiratory symptoms,fretting or sleep disorder and atenolol group(2/11,18.2%)with fretting or sleep disorder.No other serious adverse reactions occurred.No abnormality was found in physical development of neither groups during follow-ups.The developmental quotient of two groups did not differ significantly at Month 1/3/6/9 post-dosing(P>0.05).Conclusions The efficacies and complications of propranolol and atenolol are comparable for infantile hemangioma.No significant inter-group difference exists in growth and development during treatment.Regarding the impact of respiratory tract,atenolol may replace propranolol for infantile hemangiomas.