普萘洛尔联合^(90)锶-^(90)镱敷贴治疗婴幼儿大面积皮肤血管瘤的临床研究

Propranolol and ^(90)Sr-^(90)Y applicator in treatment of large area skin hemangioma in infants: a clinical study

目的对普萘洛尔(心得安)联合^(90)锶-^(90)镱(^(90)Sr-^(90)Y)敷贴治疗婴幼儿大面积皮肤血管瘤的疗效及安全性进行研究。方法将103例大面积婴幼儿皮肤血管瘤按掷硬币法分为3组:观察组47例^(90)Sr-^(90)Y敷贴治疗联合普萘洛尔处理;对照1组31例仅用^(90)Sr-^(90)Y敷贴治疗;对照2组25例仅用普萘洛尔治疗。结果观察组有效率100.0%,加重率0.0%,疗效明显优于其他2组(P<0.05);全部病例中毛细血管瘤有效率95.4%,明显高于其他2种类型;观察组毛细血管瘤、鲜红斑痣、海绵状血管瘤疗效与对照2组差异无统计学意义(P>0.05),与对照1组疗效差异有统计学意义(P<0.05);观察组1周内见效率为53.2%,快于对照1、2组(P<0.05);观察组放射性反应发生率12.8%,明显低于对照1组(P<0.05);观察组全身性反应发生率为27.7%,低于对照2组(P<0.05);普萘洛尔治疗剂量≤1.5 mg·kg-1·d-1出现全身性反应发生率27.5%;>1.5 mg·kg^(-1)·d^(-1)的患儿出现全身性反应发生率^(90).5%(P<0.05);血管瘤面积30~40 cm^2患儿治愈率为32.2%;>40 cm^2患儿治愈率9.5%,差异有统计学意义(P<0.05)。结论普萘洛尔联合^(90)Sr-^(90)Y治疗婴幼儿大面积皮肤血管瘤具有显著的临床疗效,能有效减少不良反应,有一定的临床价值,但必须掌握剂量与病灶面积。

Objective To investigate the efficacy and safety of Propranolol and ^90strontium-^90ytterbium（^90Sr-^90Y）applicator in the treatment of large area skin hemangioma in infants. Methods A total of 103 infants with large area skin hemangioma were divided into three groups by coin toss method： the study group（n=47） received ^90Sr-^90 Y applicator and Propranolol treatment; the control group 1（n=31） received ^90Sr-^90 Y applicator treatment alone; and the control group 2 received Propranolol treatment alone. Results The effective rate in the study group was 100.0%, the rate of exacerbation was 0.0%, and the effect was significantly better than that in the other two groups（P〈0.05）. The effective rate of capillary hemangioma was 95.4% in all cases, which was significantly higher than that of the other two types. There were no statistically significant differences in the effects on capillary hemangioma, port wine stains and cavernous hemangioma between the study group and the control group（P〉0.05）, and there were statistically significant differences compared with those in the control group 1（P〈0.05）. In the study group, the efficiency at 1 week was53.2%, which was faster than that in the control groups 1 and 2（P〈0.05）. The incidence of radioactive reaction in the study group was 12.8%, which was significantly lower than that in the control group（P〈0.05）. The incidence of systemic reactions in the study group was 27.7%, which was lower than that in the control group 2（P〈0.05）. When the Propranolol treatment dose ≤1.5 mg·kg^-1·d^-1, the incidence of systemic reactions was 27.5%. When the dose 〉1.5mg·kg^-1·d^-1, the incidence of systemic reactions was 90.5% in the infants（P〈0.05）. The cure rate was 32.2% in the infants with hemangioma area of 30~40 cm^2; and the cure rate was 9.5% in the infants with hemangioma area 〉40cm^2, and the differences were statistically significant（P〈0.05）. Conclusion Propranolol and ^90Sr-^90 Y show significantly clinical effect on the treatment of large area skin hemangioma in infants, which can effectively reduce the adverse reaction and have certain clinical value, whereas the dose and lesion area must be controlled.