中华皮肤科杂志 ›› 2019, Vol. 52 ›› Issue (10): 779-784.doi: 10.35541/cjd.20190196

• 药物与临床 • 上一篇    下一篇

多磺酸黏多糖减少中、低风险婴儿血管瘤治疗后发生湿疹及皮肤萎缩的多中心研究

李丽1    王华2    王榴慧3    郭艳萍4    钱秋芳5    于鲁1    宋玮3    徐锐4    林晓5    谭春花2    郝玉霜1    马琳1   

  1. 1国家儿童医学中心  首都医科大学附属北京儿童医院皮肤科  100045；2重庆医科大学附属儿童医院皮肤科  401122；3复旦大学附属儿科医院皮肤科，上海  200032；4哈尔滨市儿童医院皮肤科  150010；5上海交通大学医学院附属儿童医院皮肤科  200062
  • 收稿日期:2019-01-07 修回日期:2019-08-08 发布日期:2019-09-30
  • 通讯作者: 马琳 E-mail:bch_maleen@aliyun.com
  • 基金资助:
    首都卫生发展科研专项（首发2016-2-2093）；北京市属医院科研培育计划项目（PX2016014）；首都医科大学附属北京儿童医院“苗圃计划”项目（BCHYIPB-2016-02）

Multicenter study of Hirudoid in reducing eczema and skin atrophy of medium- and low-risk infantile hemangioma

Li Li1, Wang Hua2, Wang Liuhui3, Guo Yanping4, Qian Qiufang5, Yu Lu1, Song Wei3, Xu Rui4, Lin Xiao5, Tan Chunhua2, Hao Yushuang1, Ma Lin1#br#   

  1. 1Department of Dermatology, Beijing Children′s Hospital, Capital Medical University, National Center For Children′s Health, Beijing 100045, China; 2Department of Dermatology, Children′s Hospital of Chongqing Medical University, Chongqing 401122, China; 3Department of Dermatology, Children′s Hospital of Fudan University, Shanghai 200032, China; 4Department of Dermatology, Harbin Children′s Hospital, Harbin 150010, China; 5Department of Dermatology, Children′s Hospital of Shanghai Jiaotong University, Shanghai 200062, China
  • Received:2019-01-07 Revised:2019-08-08 Published:2019-09-30
  • Contact: Ma Lin E-mail:bch_maleen@aliyun.com
  • Supported by:
    Capital Funds for Health Improvement and Research （Grant No.2016-2-2093）; Beijing Municipal Administration of Hospitals Incubating Program （PX2016014）; “Nursery Program” of Beijing Children′s Hospital Affiliated to Capital Medical University （BCHYIPB-2016-02）

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摘要： 【摘要】 目的 探讨外用β受体阻滞剂或595 nm PDL激光治疗中、低风险婴儿血管瘤时，联合外用多磺酸黏多糖是否可减少治疗后血管瘤局部湿疹及皮肤萎缩的发生率，分析危险因素。方法 将来自全国5家儿童医院722例0 ~ 1岁中、低风险婴儿血管瘤（IH）患儿根据病情及对治疗方法的接受程度分为6组：外用β受体阻滞剂 + 外用多磺酸黏多糖（MPS）组（阻滞剂 + MPS组）、单独外用β受体阻滞剂组（阻滞剂组）、595 nm PDL激光 + 外用MPS组（PDL + MPS组）、PDL组、PDL + 阻滞剂 + MPS组、PDL + 阻滞剂组。每天外用药物2次，PDL每4周治疗1次。治疗3个月后评价疗效及不良反应。采用单因素及多因素Logistic回归分析影响IH患儿治疗过程中湿疹及皮肤萎缩发生的因素，χ2检验比较各治疗组间疗效。结果 治疗3个月时，多因素Logistic回归分析显示，阻滞剂 + MPS组与阻滞剂组IH患儿瘤体表面湿疹发生的危险因素为未联合应用MPS（P = 0.007，OR = 3.887，95% CI：1.439 ~ 10.493），而瘤体表面皮肤萎缩发生与所分析因素无明显关系。PDL + MPS组与PDL组IH患儿瘤体表面湿疹发生的危险因素包括，未联合应用MPS（P < 0.001，OR = 7.402，95% CI：2.604 ~ 21.042），北方地区（P < 0.001，OR = 67.048，95% CI：7.977 ~ 563.518）；瘤体表面皮肤萎缩发生的危险因素包括未联合应用MPS（P = 0.001，OR = 9.371，95 CI：2.590 ~ 33.900），瘤体血供丰富（P = 0.036，OR = 2.971，95% CI：1.075 ~ 8.208）。PDL + 阻滞剂 + MPS组与PDL + 阻滞剂组IH患儿瘤体表面湿疹发生的危险因素包括未联合应用MPS（P = 0.005，OR = 3.426，95% CI：1.446 ~ 8.119），北方地区（P < 0.001，OR = 31.704，95% CI：6.924 ~ 145.158）；瘤体表面皮肤萎缩发生的危险因素包括：未联合应用MPS（P < 0.001，OR = 6.011，95% CI：2.558 ~ 14.126），南方地区（P = 0.022，OR = 3.021，95% CI：1.177 ~ 7.753）。结论 中、低风险IH外用β受体阻滞剂或595 nm PDL激光治疗时，加用MPS可以减少湿疹及皮肤萎缩的发生。

关键词: 血管瘤, 婴儿, 湿疹, 多磺酸黏多糖, 皮肤萎缩, 不良反应

Abstract: 【Abstract】 Objective To investigate whether topical mucopolysaccharide polysulfate （MPS） cream can reduce the incidence of eczema and skin atrophy in patients with moderate- or low-risk infantile hemangioma after the treatment with topical beta-blockers or 595-nm pulsed dye laser （PDL）, and to analyze factors influencing the occurrence of eczema and skin atrophy. Methods A total of 722 patients aged 0 - 1 years with moderate- or low-risk infantile hemangioma were enrolled from 5 Children′s Hospitals in China. According to the disease condition and therapy acceptability, these patients were divided into 6 groups to be treated with topical beta-blockers and MPS cream （blocker + MPS group）, topical beta-blockers （blocker group）, 595-nm PDL and topical MPS cream （PDL + MPS group）, 595-nm PDL （PDL group）, 595-nm PDL combined with topical beta-blockers and MPS cream （PDL + blocker + MPS group）, and 595-nm PDL and topical beta-blockers （PDL + blocker group）, respectively. All the externally applied agents were applied twice a day, and PDL was performed once every 4 weeks. Efficacy and adverse reactions were evaluated after 3-month treatment. Univariate and multivariate Logistic regression analyses were carried out to analyze factors influencing the incidence of eczema and skin atrophy in patients with infantile hemangioma after treatment, and chi-square test was carried out to compare efficacy among the groups. Results After 3-month treatment, multivariate Logistic regression analysis for comparing the blocker + MPS group with blocker group showed that the risk factor for eczema on the surface of hemangiomas was no topical treatment with MPS cream （P = 0.007, OR = 3.887, 95% CI: 1.439 - 10.493）, while no correlations were observed between the occurrence of skin atrophy on the surface of hemangiomas and analyzed factors. Multivariate Logistic regression analysis for comparing the PDL + MPS group with PDL group showed that no topical treatment with MPS cream （P < 0.001, OR = 7.402, 95% CI: 2.604 - 21.042） and northern areas （P < 0.001, OR = 67.048, 95% CI: 7.977 - 563.518） were risk factors for eczema on the surface of hemangiomas, and risk factors for skin atrophy on the surface of hemangiomas included no topical treatment with MPS cream （P = 0.001, OR = 9.371, 95 CI: 2.590 - 33.900）and abundant blood supply of hemangiomas （P = 0.036, OR = 2.971, 95% CI: 1.075 - 8.208）. Multivariate Logistic regression analysis for comparing the PDL + blocker + MPS group with PDL + blocker group showed that risk factors for eczema on the surface of hemangiomas were no topical treatment with MPS cream （P = 0.005, OR = 3.426, 95% CI: 1.446 - 8.119）and northern areas （P < 0.001, OR = 31.704, 95% CI: 6.924 - 145.158）, and risk factors for skin atrophy on the surface of hemangiomas included no topical treatment with MPS cream （P < 0.001, OR = 6.011, 95% CI: 2.558 - 14.126） and southern areas （P = 0.022, OR = 3.021, 95% CI: 1.177 - 7.753）. After 3-month treatment, the response rate was significantly higher in the PDL group than in the PDL + MPS group （χ2 = 4.531, P = 0.033）, and significantly higher in the blocker group than in the blocker + MPS group （χ2 = 4.344, P = 0.037）. There were no significant differences in the response rate or cure rate among the other groups （all P > 0.05）. Conclusion During the treatment of moderate- or low-risk infantile hemangioma with topical beta-blockers or 595-nm PDL, the combination with topical MPS cream can reduce the occurrence of eczema and skin atrophy without affecting the therapeutic effect.

Key words: Hemangioma, Infant, Eczema, Mucopolysaccharide polysulfate, Skin atrophy, Adverse reaction

引用本文

李丽 王华 王榴慧 郭艳萍 钱秋芳 于鲁 宋玮 徐锐 林晓 谭春花 郝玉霜 马琳. 多磺酸黏多糖减少中、低风险婴儿血管瘤治疗后发生湿疹及皮肤萎缩的多中心研究[J]. 中华皮肤科杂志, 2019,52(10):779-784. doi:10.35541/cjd.20190196

Li Li, Wang Hua, Wang Liuhui, Guo Yanping, Qian Qiufang, Yu Lu, Song Wei, Xu Rui, Lin Xiao, Tan Chunhua, Hao Yushuang, Ma Lin. Multicenter study of Hirudoid in reducing eczema and skin atrophy of medium- and low-risk infantile hemangioma[J]. Chinese Journal of Dermatology, 2019, 52(10): 779-784.doi:10.35541/cjd.20190196