影响婴幼儿肝血管瘤治疗选择的因素分析

Treatment selection and influencing factors of infantile hepatic hemangioma

目的探讨婴幼儿肝血管瘤治疗方案选择的影响因素。方法回顾性分析湖南省儿童医院2013年1月至2020年7月诊治的103例婴幼儿肝血管瘤病例资料。按照治疗方法分为口服普萘洛尔组、外科治疗组(口服普萘洛尔组、外科治疗组统称为治疗组)和门诊观察组3组,比较3组的疗效、安全性,并分析婴幼儿肝血管瘤患者需要接受治疗的相关因素。结果治疗组(66例)和门诊观察组(37例)总有效率分别为84.84%和59.46%;痊愈率分别为66.66%和32.43%,治疗组疗效明显优于门诊观察组(χ^(2)=12.4,P<0.05)。口服普萘洛尔组(49例)和外科治疗组(17例)总有效率分别为79.59%和100%,痊愈率分别为61.22%和82.35%,外科治疗组疗效高于口服普萘洛尔组(χ^(2)=2.771,P<0.05)。多发型和弥漫型肝血管瘤(OR=3.085,95%CI:1.250~7.609)、合并皮肤血管瘤(OR=18.163,95%CI:14.120~23.548)、肝功能异常(OR=0.345,95%CI:0.143~0.836)、血管内皮生长因子升高(OR=2.362,95%CI:1.089~3.265)是婴幼儿肝血管瘤需要接受治疗的独立影响因素(P<0.05)。结论口服普萘洛尔或外科手术治疗婴幼儿肝血管瘤均安全有效,口服普萘洛尔是治疗多发型或弥漫型肝血管瘤的一线治疗方案。出现多发型和弥漫型肝血管瘤、合并皮肤血管瘤、肝功能异常、血管内皮生长因子升高时,提示患者需要接受治疗。

Objective To investigate the treatment choice and influencing factors of infantile hepatic hemangioma.Methods Retrospective analysis was made on the case data of 103 children with infantile hepatic hemangioma(IHH)treated in Hunan Children's hospital from January 2013 to July 2020.According to the treatment methods,they were divided into three groups:oral propranolol group,surgical treatment group and outpatient observation group.The efficacy and safety of the three groups of cases were compared and analyzed,and univariate and multivariate analyses were performed by Logistic regression to explore the predictive influencing factors for the treatment of children with IHH.Results The total effective rates of the treatment group(66 cases)and the outpatient observation group(37 cases)were 84.84%and 59.46%,respectively;the recovery rates were 66.66%and 32.43%,respectively.The curative effect of patients in the treatment group was significantly higher than that of the outpatient observation group(χ^(2)=12.4,P<0.05).The total effective rates of the oral propranolol group(49 cases)and the surgical treatment group(17 cases)were 79.59%and 100%,respectively,and the recovery rates were 61.22%and 82.35%,respectively.The surgical treatment group had higher efficacy than oral propranolol group(χ^(2)=2.771,P<0.05).Multiple and diffuse hepatic hemangioma(OR=3.085,95%CI:1.250~7.609),combined with skin hemangioma(OR=18.163,95%CI:14.120~23.548),abnormal liver function(OR=0.345,95%CI:0.143~0.836),elevated vascular endothelial growth factor(OR=2.362,95%CI:1.089~3.265)is an independent influencing factor that requires treatment for infant hepatic hemangioma(P<0.05).Conclusion Oral propranolol therapy or surgical treatment of infantile hepatic hemangioma is safe and effective.Oral propranolol therapy is the first-line treatment for multiple or diffuse hepatic hemangioma.Multiple and diffuse hepatic hemangioma,combined with cutaneous hemangioma,abnormal liver function,and elevated vascular endothelial growth factor indicate that the patient needs treatment.