Yang Kaiying,Peng Suhua,Qiu Tong,et al.Clinical study of oral propranolol treatment of infantile hepatic hemangioma[J].Journal of Clinical Pediatric Surgery,2020,19(02):145-149.[doi:10.3969/j.issn.1671-6353.2020.02.011]
口服普萘洛尔治疗婴幼儿肝血管瘤的临床研究
- Title:
- Clinical study of oral propranolol treatment of infantile hepatic hemangioma
- Keywords:
- Propranolol; Liver; Hemangioma/DT; Treatment Outcome; Child
- 分类号:
- R726;R732.2;R735.7
- 摘要:
- 目的 探讨普萘洛尔治疗婴幼儿肝血管瘤（infantile hepatic hemangioma，IHH）的临床疗效。方法 回顾性分析2013年至2018年于四川大学华西医院小儿外科接受普萘洛尔治疗的15例肝血管瘤患儿的病例资料。结果 15例患儿中男童4例，女童11例。肝脏肿大（9例，占60%）是最常见的临床表现；合并皮肤血管瘤12例（80.0%），甲状腺功能减退5例，心功能不全1例。15例患儿中，弥散性肝血管瘤2例；多发性肝血管瘤13例，其中包含2例"结合性"肝血管瘤。目前8例已经停止治疗，平均治疗时间23.8（18~30）个月；仍在治疗者6例，平均治疗时间20.5（6~41）个月；1例死于心脏衰竭和肝脏肿大引起的多器官功能障碍。治疗起始时最大瘤体平均体积为15.12 cm3，在治疗6个月后，最大瘤体平均体积为6.49 cm3，获得Ⅴ级及Ⅵ级疗效（体积消退≥50%）者8例（53.3%）；治疗12个月后，最大瘤体平均体积为3.56 cm3，获得Ⅴ级或Ⅵ级疗效者10例（83.3%）。与治疗起始时瘤体体积相比，治疗第6个月和第12个月时瘤体消退明显，疗效显著，差异具有统计学意义（P<0.05）。所有患儿平均随访时间为29.5（2~48）个月，随访期间，无一例发生低血压、低血糖、气道高反应等普萘洛尔相关严重副作用，停药后无复发。结论 口服普萘洛尔治疗IHH疗效明确，不良反应少，推荐普萘洛尔作为治疗IHH的有效选择药物。
- Abstract:
- Objective To assess the efficacy of propranolol treatment for infantile hepatic hemangioma (IHH).Methods A retrospective study of symptomatic or potentially symptomatic IHH was conducted between 2013 and 2018.Results There were 4 boys and 11 girls.Hepatomegaly (60%) was the predominant clinical presentation.Twelve (80.0%) patients had cutaneous infantile hemangiomas.Hypothyroidism (n=5) and congestive heart failure (n=1) were noted.The lesions were diffuse (n=2) and multifocal (n=13),including ’combined’ (n=2).All but one child responded well to propranolol dosing.One non-responder died from congestive heart failure and abdominal compartment syndrome.Eight children stopped dosing during a mean duration of therapy of 23.8(18.0-30.0) months.The remaining 6 patients on propranolol therapy had a mean treatment duration of 20.5(6.0-41.0) months.The average size of maximum tumor was 15.12 cm3 pre-treatment.At 6 and 12 months post-dosing,the average size of maximal tumor was 6.49 cm3 and 3.56 cm3 respectively.And Ⅴ/Ⅵ treatment response (desizing ≥ 50%) were observed in 53.3% and 83.3% at 6 and 12 months post-treatment respectively.As compared with initial treatment,propranolol dosing was associated with a dramatic sizing decline at 6 and 12 months (P<0.05).The mean follow-up period was 29.5(2.0-48.0) months.Recurrent IHH and significant side effects of propranolol were not observed during follow-ups.Conclusion Most IHH cases respond well to oral propranolol dosing.And propranolol is an alternative option for IHH due to its definite efficacy and great safety.
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备注/Memo
收稿日期:2019-08-14。
基金项目:国家自然科学基金资助项目（编号：81401606/81400862）；四川大学优秀青年学者基金资助项目（编号：2015SU04A15）；四川省科技厅重点研发项目（编号：2019YFS0322）；四川大学华西医院临床孵化项目（编号：2019HXFH056）
通讯作者:吉毅,Email:jijiyuanyuan@163.com