Randhawa Harkamal Kaur, Sibbald Cathryn, Garcia Romero Maria Teresa, Pope Elena
Section of Dermatology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Pediatr Dermatol. 2015 Sep-Oct;32(5):690-5. doi: 10.1111/pde.12655. Epub 2015 Jul 27.
Beta-blockers have become the treatment of choice for problematic infantile hemangiomas (IHs). Nadolol, a nonselective beta-blocker with potential dosing advantages and a better safety profile than that of other beta-blockers, has been studied as an alternative therapeutic option. Our objective was to characterize the efficacy and safety of oral nadolol in the treatment of proliferating IHs.
A retrospective cohort study was conducted at the Hospital for Sick Children between February 2010 and April 2012 in patients treated with nadolol for proliferating IHs causing functional impairment or cosmetic disfigurement. The primary outcome was the percentage involution measured independently by two assessors who scored changes in the extent of IHs by comparing serial photographs using a 100-mm visual analogue scale (VAS), on which 5 mm represented 10% change.
Forty-four patients treated with nadolol for IHs with adequate photographic documentation were identified. The median age at presentation was 4.5 months (interquartile range 1.5-7.9 mos). There was a mean improvement of 91.8 ± 11.1%. At least 50% improvement was noted in 42 (95%) patients and 75% improvement in 39 (89%) patients. The mean time to 50% and 75% improvement was 2.9 and 3.7 months, respectively. Analysis of variance showed that younger age at the time of treatment start was associated with a higher mean VAS score (% involution) (p < 0.05). Treatment duration (mean 9.5 ± 5.6 months) had no significant effect on VAS score. Test of interobserver correlation showed good agreement (intraclass correlation coefficient = 0.86, p = 0.001).
Oral nadolol is efficacious in patients with problematic IHs. Further large-scale prospective comparative studies are warranted to compare nadolol with other beta-blockers.
β受体阻滞剂已成为治疗复杂性婴儿血管瘤（IHs）的首选药物。纳多洛尔是一种非选择性β受体阻滞剂，具有潜在的给药优势，且安全性优于其他β受体阻滞剂，已被作为一种替代治疗选择进行研究。我们的目的是描述口服纳多洛尔治疗增殖期IHs的疗效和安全性。
2010年2月至2012年4月在病童医院对因增殖期IHs导致功能障碍或美容缺陷而接受纳多洛尔治疗的患者进行了一项回顾性队列研究。主要结局是由两名评估者独立测量的消退百分比，他们通过使用100毫米视觉模拟量表（VAS）比较系列照片来对IHs范围的变化进行评分，其中5毫米代表10%的变化。
确定了44例接受纳多洛尔治疗IHs且有充分照片记录的患者。就诊时的中位年龄为4.5个月（四分位间距1.5 - 7.9个月）。平均改善率为91.8±11.1%。42例（95%）患者改善至少50%，39例（89%）患者改善75%。达到50%和75%改善的平均时间分别为2.9个月和3.7个月。方差分析显示，开始治疗时年龄较小与较高的平均VAS评分（消退百分比）相关（p<0.05）。治疗持续时间（平均9.5±5.6个月）对VAS评分无显著影响。观察者间相关性检验显示一致性良好（组内相关系数 = 0.86，p = 0.001）。
口服纳多洛尔对复杂性IHs患者有效。有必要进行进一步的大规模前瞻性比较研究，以比较纳多洛尔与其他β受体阻滞剂。
