口服普萘洛尔治疗中、高风险婴幼儿血管瘤后的再发现象

Rebound Growth of Propranolol Therapy for the Treatment of Medium and High Risk Infantile Hemangiomas

目的探讨口服普萘洛尔治疗中、高风险婴幼儿血管瘤的疗效和再发现象。方法2013年3月至2015年3月在我科就诊的中、高风险血管瘤患儿151例,给予口服普萘洛尔治疗:起始剂量为0.5 mg/Kg·d,前3天每天增加0.25 mg/Kg·d,至1.0 mg/Kg·d,最大剂量为2 mg/Kg·d。治疗前、治疗中、治疗后进行全血检测及多普勒超声检查。共持续口服普萘洛尔治疗6~12个月,并随访3年以观察后续疗效。结果共完成治疗和随访141例,完成率93.38%。本组患儿首次服药时为(2.32±0.85)月龄,平均口服普萘洛尔持续时间(9.61±4.06)个月。141例患者中,共有55例出现不同程度的血管瘤再发现象,再发率为39.01%。首次服药年龄<6月龄时,再发概率较高,但无明显统计学意义(P>0.05)。病灶位于头面部的患儿再发概率明显高于其他患儿(P<0.05)。结论口服普萘洛尔治疗血管瘤可出现再发现象,故建议逐渐减量并延长服药周期以减少再发现象。

Objective To study the efficacy and rebound growth of propranolol for the treatment of medium and high risk infantile hemangiomas.Methods From March 2013 to March 2015,151 cases with medium and high risk infantile hemangiomas were treated with oral propranolol.The dose of oral propranolol started at 0.5 mg/Kg·d with an increase by 0.25 mg/Kg·d everyday at the first 3 days,up to 1.0 mg/Kg·d,and the maximum dose was 2 mg/Kg·d.Complete blood tests and doppler ultrasound were obtained before,during and after treatment.The total treatment cycle last 6-12 months,with a 3-year period of follow-up study for clinical observation.Results A total of 151 patients were enrolled,and 141 patients completed the therapy and follow-up,the completion rate was 93.38%.The average age of first therapy was 2.32±0.85 months,the average duration of oral propranolol was 9.61±4.06 months.There were 55(39.01%)patients had rebound growth during propranolol therapy.The patients whose first therapy age under 6-month had the higher risk of rebound growth,but there was no statistically significant difference(P>0.05).The pathogenic site of head and face region hemangiomas had the higher risk of rebound growth than other regions(P<0.05).Conclusion Oral propranolol in the treatment of hemangioma can appear rebound growth,so it is recommended to gradually reduce the dosage and lengthen the medication period to reduce rebound and recurrence.