探讨口服普萘洛尔治疗婴幼儿血管瘤的时机及安全性

Timing and safety of oral propranolol for infantile hemangioma

目的探讨口服普萘洛尔治疗婴幼儿血管瘤的时机及安全性。方法收集2013年1月至2018年1月于四川省医学科学院/四川省人民医院,儿童医学中心,仅经口服普萘洛尔治疗的血管瘤患儿(年龄1~12个月)。随访记录对比病灶变化、有无副作用及复发等情况。数据均由χ2检验评估,P<0.05为差异具有统计学意义。结果满足本研究条件的患儿共271例,其中男85例,女186例。治疗完成后,随访时间为(9.2±3.5)个月,200例疗效达优/良,71例疗效中/差。按开始治疗年龄分为两组"≤3个月组" 96例与">3个月组" 175例,"≤3个月组"的治疗效果明显优于">3个月组"(χ2=10.274,P=0.001)。按病灶部位分为三组"头颈部组" 178例、"四肢组" 32例和"躯干及会阴组" 61例,三组之间的治疗效果无差异(χ2=1.261,P=0.532)。按病灶大小分为两组">10 cm组" 77例与"≤10 cm组" 194例两组,两组之间的治疗效果无差异(χ2=3.185,P=0.092)。按病灶分布类型分为两组"单发型组" 218例与"多发型组" 53例,两组之间治疗效果无差异(χ2=1.010,P=0.385)。治疗及随访期间出现呼吸道问题的病例共116例、腹泻57例、失眠或嗜睡35例、呕吐24例、便秘8例、食欲下降5例、心率下降2例、血压下降1例。治疗完成后随访期间有26例复发。结论口服普萘洛尔治疗婴幼儿血管瘤,治疗效果好、安全性高、副作用少且温和。在患儿≤3个月时采用普萘洛尔治疗的疗效明显优于>3个月的患儿。

Objective To explore the therapeutic outcomes and complications of oral propranolol for infantile hemangiomas (IHs). Methods A retrospective analysis was conducted for IHs patients receiving oral propranolol from January 2013 to January 2018 at our department. Medical records were reviewed for demographic information, lesion characteristics, therapeutic outcomes and complications. And χ2 test was employed for evaluating the prognostic effects of these characteristics. Results Oral propranolol was offered for 271 IHs patients. After treatment, the mean follow-up duration was (9.2±3.5) months. The outcomes were excellent/good (n=200) and fair/poor (n=71). The monthly age was ≤3 (n=96) and >3 (n=175). The locations included head & neck (n=178), extremities (n=32) and trunk & perineum (n=61). The size was ≤10 cm (n=194) and >10 cm (n=77). The distribution was single (n=218) and multiple (n=53). IHs≤3 months was more likely to have good/excellent outcomes than those >3 months (χ2=10.274, P=0.001). No other lesion characteristic significantly affected the good/excellent outcomes, including lesion locations (χ2=1.261, P=0.532), lesion sizes (χ2=3.185, P=0.092) or lesion distributions (χ2=1.010, P=0.385). During or after treatment, there were respiratory problems (n=116), diarrhea (n=57), sleep problems (n=35), vomiting (n=24), constipation (n=8), anorexia (n=5), bradycardia (n=2) and hypotension (n=1). During follow-ups, 26 IHs patients had relapses. Conclusions Oral propranolol is both safe and effective for IHs children. Especially for those aged under 3 months, the outcomes are generally good/excellent.