口服普萘洛尔治疗婴幼儿血管瘤及对血清VEGF及PEDF的影响

Effects of Oral Propranolol on Infantile Hemangioma and Serum VEGF and PEDF Levels

目的探讨口服普萘洛尔治疗婴幼儿增生期血管瘤及对血清血管内皮生长因子(VEGF)及色素上皮衍生因子(PEDF)的影响。方法选取72例增生期血管瘤患儿为增生期血管瘤组(增生组),消退期血管瘤患儿60例作为消退期血管瘤组(消退组),选取40例同期健康体检的婴幼儿作为正常对照组。增生组给予普萘洛尔0.5~2.0 mg·kg^(-1)·d^(-1)口服治疗12周。采用ELISA法检测增生组(治疗前、治疗4周、治疗8周、治疗12周)、消退组及正常对照组血清VEGF、PEDF水平变化,并分析增生组VEGF、PEDF水平与疗效的相关性。结果增生组治疗总有效率为93.06%;增生组血清VEGF水平高于正常对照组及消退组(P<0.05),血清PEDF水平低于正常对照组及消退组(P<0.05)。增生组血清VEGF水平在治疗前、治疗4周、治疗8周、治疗12周依次降低(P<0.05),血清PEDF水平依次升高(P<0.05);增生组治疗12周血清VEGF下降水平与疗效呈正相关(r=0.489,P<0.05),血清PEDF上升水平与疗效呈正相关(r=0.380,P<0.05);增生组治疗前与治疗12周时血清VEGF下降水平与PEDF上升水平呈正相关(r=0.369,P<0.05)。结论普萘洛尔治疗增生期婴幼儿血管瘤疗效机制可能与下调血清VEGF水平、上调PEDF水平相关。

Objective To investigate the effects of oral propranolol on proliferating hemangioma and serum vascular endothelial growth factor(VEGF)and pigment epithelial-derived factor(PEDF)levels in infants.Methods Seventy-two cases of proliferating hemangioma and 60 cases of regressing hemangioma were selected in this study.In addition,40 healthy subjects were recruited as the normal control group.The proliferating hemangioma group was orally treated with propranolol(0.5-2.0 mg·kg^(-1)·d^(-1))for 12 weeks.Serum VEGF and PEDF levels were detected by ELISA in all the three groups before treatment and 4,8 weeks and 12 weeks after treatment.Furthermore,the relationships of VEGF and PEDF levels to curative effect were analyzed in the proliferating hemangioma group.Results The total effective rate was 93.06%in the proliferating hemangioma group.Compared with the normal control group and the regressing hemangioma group,serum VEGF level increased but PEDF level decreased in the proliferating hemangioma group(P<0.05).Moreover,VEGF level decreased but PEDF level increased successively before treatment,4 weeks after treatment,8 weeks after treatment and 12 weeks after treatment in the proliferating hemangioma group(P<0.05).At 12 weeks after treatment,the curative effect was positively correlated with the decrease in VEGF level(r=0.489,P<0.05),as well as with the increase in PEDF level(r=0.380,P<0.05).Before treatment and at 12 weeks after treatment,the decreased VEGF level was positively correlated with the increased PEDF level(r=0.369,P<0.05).Conclusion The mechanism of propranolol action in infantile hemangioma may be related to down-regulation of VEGF and up-regulation of PEDF in serum.