普萘洛尔作为严重婴幼儿血管瘤一线治疗的前瞻性研究

A prospective study of propranolol as first-line treatment for problematic infantile hemangioma inChina

目的前瞻性评价普萘洛尔作为一线方案治疗严重婴幼儿血管瘤的疗效和安全性。方法2009年3月至2010年2月对78例严重婴幼儿血管瘤患儿口服普萘洛进行治疗，用药剂量为每天2mg／kg。患儿性别、年龄、肿物部位、并发症以及患儿入选该治疗的指征、不良反应、停药后有无复发等均被详细记录。针对服药后1周、1个月和停药时疗效分别评价。平均随访时间为16．7个月（12．1～23．6个月）。结果初始服药平均年龄为3．7个月（1．1～9．2个月），停止服药的平均年龄为11．2个月（5．2—22．3个月）。疗程平均7．6个月（2．1～18．3个月）。所有患儿口服普萘洛尔1周后肿物生长有效控制，其中88．5％（69／78）的患儿表现为促进消退。服药1个月和停药时，表现为促进消退的患儿达98．7％（77／78）。14例伴发溃疡的血管瘤患儿，溃疡在服药后2个月内均愈合。15．4％（12／78）患儿有轻微不良反应。35．9％（28／78）患儿停药后有复发倾向。结论普萘洛尔治疗婴幼儿血管瘤疗效明显，不良反应小，可作为严重婴幼儿血管瘤的一线治疗。

Objective To prospectively assess the efficacy and safety of propranolol as a first-line treatment for problematic infantile haemangioma in China. Methods From Mar. 2009 to Feb. 2010, 78 patients with problematic infantile hemangioma were included in the prospective study. The characteristics of the tumor, including sex, age, site, complications, were recorded. The response to treatment at 1 week, at 1 month and at the end of treatment was evaluated. The efficacy of treatment was graded as no response, stabilization, or accelerated regression. The indications for treatment, side effects and relapse after treatment were documented. The mean follow-up period was 16.7 months （range, 12. 1-23.6 months）. Results Oral therapy was initiated at mean age of 3.7 months （ range, 1.1-9. 2 months） as first-hne therapy. The mean age at the end of treatment was 11.2 months （ range, 5.2-22.3 months）. The treatment was lasted for 7.6 months （range, 2.1-18.3 months）. One week after treatment beginning, the hemangioma growth was controlled in all the patients. The accelerated regression was achieved in 88.5% （69/78） of patients after one week of treatment, and 98.7% （77/78） of patients after I month of treatment and at the end of treatment. Ulceration was occurred in 14 cases before treatment, which was healed after treatment for 2 months. Minor side effects were happened in 15.4% （12/78） of patients. Rebound growth of lesion was noticed in 35.9% （28/78） of patients. Conclusions Propranolol is effective in the treatment of infantile hemangioma with minor side effect. We suggest it should be used as the first-line treatment.