口服普萘洛尔治疗婴幼儿血管瘤的临床效果分析

Clinical analysis for treatment of 1 080 cases of infantile hemangiomas with oral propranolol

目的 观察口服普萘洛尔治疗不同类型婴幼儿血管瘤的临床效果,并探讨其适应证.方法 回顾性分析2008年10月至2013年6月已完成口服普萘洛尔治疗并随访满6个月的血管瘤患儿共1 080例的临床资料,其中男338例,女742例.根据病变表现分为5型：小血管扩张型58例,丘疹型424例,肥厚型106例,深部型176例,混合型316例.均接受口服普萘洛尔治疗,剂量为1.0 ～ 1.5 mg/kg顿服（年龄≤2.5个月患儿1.0 mg/kg,＞2.5个月患儿1.5 mg/kg）1次/d,住院治疗1周后出院连续服药,动态观察和记录血管瘤大小、质地、颜色变化,观察并随时处理治疗过程中出现的不良反应.服药1年或服药未满1年但瘤体已经完全消退时停药.按4级评分法对近期疗效进行评价.结果 服药后5型瘤体开始出现变化时间分别为：小血管扩张型8.0（3.7,16.2）h、丘疹型6.5（4.1,14.3）h、肥厚型后7.0（5.5,12.7）h、深部型7.5（3.8,11.3）h、混合型6.5（4.2,13.4）h,差异无统计学意义（x2=1.738,P＞0.05）.随访6个月～2.5年,远期疗效评定为Ⅳ级（优）者378例（35.00％）,Ⅲ级（好）574例（53.15％）,Ⅱ级（中）120例（11.11％）,Ⅰ级（差）8例（0.74％）.深部型疗效Ⅳ级者占59.09％（104/176）,混合型和丘疹型疗效Ⅳ级者分别占51.26％（162/316）和26.41％（112/424）.结论 口服普萘洛尔治疗深部型、混合型和丘疹型血管瘤临床效果好,而治疗小血管扩张型和肥厚型血管瘤效果欠佳.

Objective To explore the indications of hemangiomas of different types by observing the clinical efficacy of oral propranolol.Methods For this retrospective study from October 2009 to June 2013,a total of 1 080 cases were classified into 5 types according to their clinical characteristics.There were 338 males and 742 females.Their types were telangiectasis （n =58）,papular （n =424）,plump （n =106）,deep （n =176） and mixed （n =306）.Propranolol was orally administered at a dose of 1.0 or 1.5 mg/kg daily （1.0 mg/kg for infants aged 2.5 months or under; 1.5 mg/kg for those aged 2.5 months or above）.Dynamic observations of hemangioma size,texture or color change and adverse events during treatment were performed.Drug withdrawal was usually made after dosing for 1 year or under when there was a total regression of hemandiomas.The efficacy was evaluated on a 4-level scale.Results Rank test results showed no significant differences between 5 types during the changes of lesions （x2 =1.738,P 〉 O.05）.Changing of lesions occurred 8.0 （3.7,16.2） hours after dosing in telangiectasis type,whereas 6.5 （4.1,14.3） hours in papular type,7.0 （5.5,12.7） hours in plump type,7.5 （3.8,11.3） hours in deep type and 6.5 （4.2,13.4） hours in mixed type.After a follow-up of 6 months to 2.5 years,there were 378 grade Ⅳ case （35.00%）,574 grade Ⅲ case （53.15%）,120 grade Ⅱ cases （11.11%） and 8 grade Ⅰ cases （0.74%）.And there were significant differences between patients of different types （P 〈 0.05）.Patients of deep type had the best grade Ⅳ curative effect rate of 59.09% （104/176）,then papular type of 51.25% （162/316） and telangiectasis type of 26.41% （112/424）.Conclusion As a first-line treatment for hemangioma,propranolol shows excellent efficacies for patients of deep,mixed,plaque and papular types.