浅表婴儿血管瘤分布特点与疗效的关系探讨

Association of lesion distribution of superficial infantile hemangioma with therapeutic efficacy

目的:探讨浅表婴儿皮肤血管瘤(IH)皮损特点与疗效的关系。方法:纳入77例未经任何治疗的浅表IH患儿,按照初诊时皮损分布特点分为散在分布组(A组)41例和融合分布组(B组)36例。两组均使用激光联合外敷马来酸噻吗洛尔滴眼液治疗,每次激光治疗后1周开始外敷药水,瘤体基本消退时停止治疗。取入选病例皮损周边正常皮肤作为对照组。分别于治疗前、治疗后4、8、12、16、20周,检测血红素(EI)值。治疗后每4周评价疗效、记录激光次数及不良反应。结果:①治疗4周后,A组有效率为21.95%,B组有效率为5.56%,差异有统计学意义(x^2=4.21,P<0.05)。治疗时间越长,两组有效率差异越明显。②A组平均激光治疗(1.54±0.81)次,B组平均激光治疗(2.89±1.21)次,两组比较差异有统计学意义(t=5.67,P<0.01)。③治疗前B组EI值(811.91±198.86)明显高于A组(676.14±158.14)及对照组(314.58±27.00),三组比较差异有统计学意义(F=91.95,P<0.01)。治疗16周后,A组EI值已明显下降,与对照组比较差异无统计学意义(P>0.05);B组EI值仍明显高于A组及对照组,三组比较差异有统计学意义(F=50.42,P<0.01)。结论:散在分布的浅表IH比融合分布的浅表IH激光治疗次数少,疗程短,有效率高。

Objective:To investigate the relationship between the distribution characteristics of skin lesions of superficial infantile hemangioma(IH)and therapeutic efficacy.Methods:Seventy seven children with superficial IH were enrolled.According to the distribution characteristics of skin lesions before any treatment,patients were divided into diffuse distribution group(group A)and fuse distribution group(group B).Both groups were treated with laser at 1-month interval,and topical applications of timolol maleate eye drops twice-daily starting one week after each laser treatment until skin lesions almost completely disappeared.Perilesional uninvolved skin served as control site.Erythema index(EI)was measured before treatment,4,8,12,16,and 20 weeks after treatment.The therapeutic efficacy was evaluated every 4 weeks after treatment,and number of laser treatment and adverse reactions were also recorded.Results:Following 4-week treatment,the effective rate was higher in group A than in group B(21.95%vs.5.56%,x^2=4.21,P<0.05).The difference in effective rates between these two groups became more prominent with prolonged treatment period.The average number of laser treatment was fewer in group A than in group B(1.54±0.81 times vs.2.89±1.21 times,t=5.67,P<0.01).Prior to the treatment,EI in group B(811.91±198.86)was significantly higher than that in group A(676.14±158.14)and the controls(314.58±27.00)(F=91.95,P<0.01).Sixteen-week treatments markedly lowered EI in group A to a comparable level to that in the controls(P>0.05),while EI in group B was still significantly higher than that in group A and the controls(F=50.42,P<0.01).Conclusion:Compared with the fuse superficial IH,the diffuse superficial IH requires fewer number of treatment,and responds better to laser treatment.