中华皮肤科杂志 ›› 2012, Vol. 45 ›› Issue (7): 466-469.

• 论著 • 上一篇    下一篇

普萘洛尔治疗婴儿血管瘤的临床疗效及安全性

杨舟1,李丽2,徐子刚3,孙玉娟3,张立新3,张霞2,褚岩4,燕丽2,刘盈4,肖媛媛2,向欣1,王忱2,马琳2   

  1. 1. 北京儿童医院
    2. 首都医科大学附属北京儿童医院
    3. 北京首都医科大学附属北京儿童医院皮肤科
    4. 首都医科大学附属北京儿童医院皮肤科
  • 收稿日期:2012-01-29 修回日期:2012-04-09 出版日期:2012-07-15 发布日期:2012-07-02
  • 通讯作者: 马琳 E-mail:bch_maleen@yahoo.cn

Efficacy and safety of propranolol in treating infantile hemangiomas

  • Received:2012-01-29 Revised:2012-04-09 Online:2012-07-15 Published:2012-07-02

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摘要：

目的 评估口服普萘洛尔治疗婴儿血管瘤的临床疗效及安全性。方法 2010年7月至2011年11月北京儿童医院皮肤科病房收治血管瘤患儿90例，予口服普萘洛尔1.5 ～ 2.0 mg·kg-1·d-1治疗，每月复诊记录瘤体变化，根据体重调整用药剂量，并监测服药前后患儿的血糖、心率、血压、肝肾功能、心肌酶、心电图、血管瘤局部超声等变化情况，观察疗效及安全性。结果 90例患儿中82例（91.1%）口服普萘洛尔后24 ～ 48 h起效。用药1 ～ 10个月的患儿88例，用药后瘤体缩小0 ～ 25%或瘤体表面颜色较前变浅7例（8.0%），瘤体缩小26% ～ 50%或瘤体表面颜色较前明显变浅35例（39.8%），瘤体缩小51% ～ 75%且瘤体表面颜色较前明显变浅23例（26.1%），瘤体缩小大于75%或瘤体表面颜色消退23例（26.1%）。用药3 ～ 4个月疗效均优于1 ～ 2个月；用药5 ～ 6个月疗效优于3 ～ 4个月；7 ～ 8个月疗效优于5 ～ 6个月。初步观察患儿于10个月至1岁4个月间停药后瘤体未见反弹。治疗过程中可出现低血压、睡眠障碍、稀便、低血糖、肢端发凉、气道高反应、肝功能异常、心肌酶异常，大部分于用药早期出现，经随诊或对症治疗后可好转。结论 普萘洛尔可抑制增生期血管瘤生长，并加速其消退，部分患儿效果显著；对消退期血管瘤初步观察亦有促进消退作用。治疗过程中不良反应程度较轻，但需严密监测，及时对症处理。

关键词: 血管瘤

Abstract:

Objective To evaluate the clinical efficacy and safety of propranolol in treating infantile hemangiomas. Methods Ninety children with hemangioma collected from July 2010 to November 2011 were recruited in this study. Oral propranolol was given at a dose of 1.5－2.0 mg/kg per day, and the dose was adjusted according to the growth of body weight. Patients were revisited every month for the observation of appearance of hemangioma. The following parameters, including blood glucose, alanine transarninase, aspartate aminotransferase, urea nitrogen, creatinine, creatine kinase, heart rate, blood pressure, electrocardiogram and ultrasound image of hemangioma, were monitored before and after the administration of propranolol. Results A rapid halt in haemangioma proliferation was seen in 91.1% （82/91） of the patients within 24－48 hours after the administration of propranolol. After 1－10 months of treatment, haemangioma shrunk by 0－25% with a lightening of lesional color in 8.0%（7/88） of the patients, by 26%－50% with an obvious lightening of lesional color in 39.8% （35/88）, by 51%－75% with a marked lightening of lesional color in 26.1% （23/88）, and 26.1% （23/88） of the patients achieved a shrinkage of more than 75% or fading of lesional color. The 7－8 months of treatment leaded to the best outcome, followed by 5－6 months, 3－4 months, and 1－2 months, of treatment. No rebound was observed in patients who stopped the treatment at 10 months to 1 year and 4 months of age. Usually during early stage of the therapy, some of the patients suffered from reduced diastolic blood pressure, sleep disorder, loose stools, hypoglycemia, cold extremities, bronchial hyperreactivity, elevated alanine transarninase/aspartate aminotransferase or creatine kinase isoenzyme, most of which were tolerable and relieved with or without symptomatic treatment. Conclusions Propranolol can suppress the growth and accelerate the regression of hemangiomas in proliferative phase, and also can promote the subsidence of hemangiomas in regressive phase. The side effects of propranolol are usually mild, but still need close monitoring.

Key words: hemangiomas