Katona Gábor, Csákányi Zsuzsanna, Gács Eva, Szalai Zsuzsanna, Ráth Gábor, Gerlinger Imre
Department of Pediatric Otorhinolaryngology & Bronchology, Heim Pál Children's Hospital, Budapest, Hungary.
Int J Pediatr Otorhinolaryngol. 2012 Dec;76(12):1746-50. doi: 10.1016/j.ijporl.2012.08.014. Epub 2012 Sep 1.
Discuss effect and dynamics of propranolol (PR) treatment in infantile haemangioma (IH) of head and neck in children during follow-up.
Between 2010 and 2011, 22 children with head and neck infantile haemangioma (IH) treated by PR were recruited into the study. In a retrospective chart review clinical data were analyzed at 5 consecutive, different check-up time from 1 week to 12-14 months. Effectiveness of PR treatment was assessed by a symptom score method.
In the whole series a significant regression was observed in 13 patients (59%) in the first week of the therapy. Further five patients showed this time a marked, two mild improvements, and two children did not respond initially to the PR therapy. In one of them (case #8) later on a mild improvement could be seen too. At the second check-up (1 month after initiating PR therapy) 50% of children showed definitive improvement compared to the first visit. Difference between first and second check-ups was significant, and between the 4th and 5th visits the improvement showed the lowest rate. Comparison of IH regression between the 2nd and the 5th check-ups resulted in a p value a little larger than 0.05. There was not significant correlation between the initial IH severity and the treatment effectiveness at the follow-ups (p>0.05). No significant differences were found in treatment effectiveness concerning the IH localizations, too.
PR treatment is highly effective in children with IHs. The most striking effect is seen at the first week of treatment; later improvement is much slower, sometimes with periods of stagnations. The cause of this is probably the spectacular early effect of vasoconstriction, though other impacts of PR to the individual molecular markers of IH seemed to be less impressive clinically. However, treatment should be continued for at least 6 months because early cessation can cause a relapse.
探讨普萘洛尔（PR）治疗儿童头颈部婴幼儿血管瘤（IH）的疗效及随访期间的动态变化。
2010年至2011年，招募了22例接受PR治疗的头颈部婴幼儿血管瘤患儿。通过回顾性病历审查，在连续5个不同的检查时间点（从1周龄至12 - 14个月龄）分析临床数据。采用症状评分法评估PR治疗的有效性。
在整个系列中，13例患者（59%）在治疗的第一周观察到显著消退。另外5例患者此时有明显改善，2例轻度改善，2例患儿最初对PR治疗无反应。其中1例（病例#8）后来也出现了轻度改善。在第二次检查（开始PR治疗1个月后），与首次就诊相比，50%的患儿显示出明确改善。首次和第二次检查之间的差异显著，而在第4次和第5次就诊之间改善率最低。第2次和第5次检查之间IH消退情况的比较得出p值略大于0.05。初始IH严重程度与随访时的治疗效果之间无显著相关性（p>0.05）。在IH不同部位的治疗效果方面也未发现显著差异。
PR治疗对患有IH的儿童非常有效。最显著的效果出现在治疗的第一周；后期改善要慢得多，有时会有停滞期。其原因可能是血管收缩的早期显著效应，尽管PR对IH的个体分子标志物的其他影响在临床上似乎不太明显。然而，治疗应至少持续6个月，因为过早停药可能导致复发。
