普萘洛尔治疗婴幼儿血管瘤的系统评价

Propranolol for treatment of infantile hemangioma., a systematic evaluation

目的系统评价普萘洛尔治疗婴幼儿血管瘤的疗效和不良反应。方法检索Coehrane、Medline、Wiley、中国期刊全文数据库及万方医学数据库，以血管瘤、普萘洛尔、婴幼儿为关键词，检索自2008年6月至2013年5月问有关单纯口服普萘洛尔治疗婴幼儿血管瘤的临床研究。对有效率和不良反应进行描述性评价。结果共纳入23篇文献。16篇为非随机、非对照研究，其中14篇为病例报告，2篇为随访研究；6篇为临床对照试验；1篇为随机对照研究（RcT）。纳入患儿共716例，均未曾接受过其他治疗，初始治疗平均年龄为（4．5±0．5）个月，日均用药量为2．1mg／kg，平均疗程为（9．7±9．2）个月，治疗总有效率为96．5％（691／716），复发率为8．6％（28／327），不良反应发生率为31％（223／716），最常见的不良反应为心率减慢（73例），胃肠道反应（52例），睡眠改变（35例），其中5例因严重不良反应而终止治疗。结论普萘洛尔治疗婴幼儿血管瘤疗效显著，不良反应较少，是一种较理想的治疗婴幼儿血管瘤的方法，但治疗过程中应注意严重不良反应导致的生命危险，严格选择适应证。

Objective To systematically review the literature evaluating efficacy and adverse e- vents of propranolol for infantile hemangiomas （IHs）. Methods We searched the Cochrane, Medline, Wiley, CNKI and Wanfang Databases for all studies on the response of IHs to propranolol only which were published between June 2008 and May 2013. Results A total of 23 studies were collected, inclu- ding 14 case reports and 2 follow-up studies which were without random and control; another 6 studies were clinical controlled trials and 1 study was RCT. Total 716 patients were included, and never re- ceived other treatments before propranolol. Propranolol was initiated at a mean age of （4.5 ＋ 0.5） months at a mean dose of 2.1 mg/kg/day and for a mean treatment duration of （9.7±9.2） months. The effective rate for patients with IHs treated with propranolol was 97% （691/716）, and patients after treatment completion reported IHs recurred in 8.6% of patients. The adverse effects rate was 31%（223/7167） which most common adverse events were changes in sleep （n = 35）, gastrointestinal reac- tion （n =52） and decreased heart rate （n =73）, and 5 patients discontinued the treatment because of the serious adverse events. Conclusions This systematic review of 716 patients treated with propranolol for IHs show a high rate of efficacy and a low rate of serious adverse events, and it is a better treatment of infantile hemangioma, but we should pay more attention to the serious adverse events and strictly select indications.