口服普萘洛尔治疗婴幼儿增生期血管瘤疗效分析及血清血管内皮生长因子的变化

Clinical efficacy of oral propranolol for the treatment of infant proliferating hemangiomas and the changes of serum VEGF

目的：探讨口服普萘洛尔治疗婴幼儿增生期血管瘤的作用机制及临床疗效。方法：对42例增生期血管瘤患儿，给予普萘洛尔0．5～1．5mg／（kg·d）连续服用，服药3~8个月。采用ELISA法检测患儿治疗前、治疗4周、治疗8周时血清血管内皮生长因子（VEGF）的水平，并观察临床疗效及不良反应。结果：①42例增生期血管瘤患儿I级疗效有1例，Ⅱ级疗效2例，Ⅲ级疗效23例，Ⅳ级疗效16例，有效率（优加好）为92．9％。②42例增生期血管瘤在普萘洛尔治疗4周、8周时血清VEGF水平呈下降趋势，且治疗4周时低于治疗前（P〈0．05），治疗8周时低于治疗4周时（P〈0．05）；治疗4周后血清VGEF下降水平与疗效等级具有正相关性（rs=0．705，P〈0．05），治疗8周后血清VGEF下降水平与疗效等级亦具有正相关性（rs=0．821，P〈0．001）。结论：普萘洛尔治疗婴幼儿增生期血管瘤疗效显著，不良反应轻微，其机制可能与下调增生期血管瘤患儿血清VEGF水平相关。

Objective： To explore the mechanism and clinical efficacy of propranolol for the treatment of infant proliferating hemangiomas by assessing the changes of serum vascular endothelial growth factor （VEGF）. Methods： From December 2011 to March 2013, 42 infants with proliferating hemangiomas were treated with oral propranolol at a dose of 0.5-1.5 mg/（kg·d） for 3 to 8 months. Enzyme-linked immunosorbent assay （ELISA） was used to determine surum VEGF levels before, at 4 and 8 weeks after treatment. The clinical efficacy and adverse reactions were also observed. Results： （1）Of 42 cases, 1 case was scale, 2 cases were scale Ⅱ, 23 cases were scale Ⅲ and 16 cases were scale Ⅵ. The total effective rate was 92.9%. The serum VEGF levels gradually decreased during the treatment. The serum VEGF level was significantly lower after 4-week treatment （P〈 0.05）. The level of serum VEGF after 8-week treatment also was significantly lower than that after 4-week treatment（P〈0.05）. Following 4-and 8-week treatments, the decreased levels of serum VEGF were positively correlated with the grade of efficacy （rs=0.705, 0.821, P〈0.05, P〈0.001）. Conclusion： Propranolol is safe and effective for the infant proliferating hemangiomas with mild adverse reactions. The mechanism may be associated with the down-regulation of serum VEGF.