Steineger Johan, Osnes Terje, Heimdal Ketil, Dheyauldeen Sinan
Department of Otorhinolaryngology-Head and Neck Surgery.
Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.
Laryngoscope. 2018 Oct;128(10):2237-2244. doi: 10.1002/lary.27147. Epub 2018 Feb 22.
OBJECTIVES/HYPOTHESIS: Long-term follow-up of intranasal bevacizumab therapy in hereditary hemorrhagic telangiectasia (HHT).
Prospective, noncomparative study.
Patients treated for HHT-associated epistaxis by intranasal submucosal bevacizumab injections between June 2011 and August 2013 were included and followed prospectively. The effectiveness of the treatment was evaluated by the epistaxis severity score (ESS); the epistaxis intensity, frequency, and the need of blood transfusion (IFT) score; and hemoglobin levels.
Thirty-three patients were included. The total number of treatments with intranasal bevacizumab injection was 210. The mean number of treatments per patient was 6.2 ± 4.6 (range, 1-16), and the mean treatment and observation period was 38.8 ± 21.8 months (range, 2-66 months). Four patients showed no improvement after treatment. Eleven patients (33.3%) showed initial improvement in both ESS and IFT, but the treatment was discontinued before the end of the study because the effect became gradually shorter lasting despite repeated injections. Twelve patients (36.3%) continued to have a positive response to the treatment at the end of the study. No local adverse effects were observed, but one patient developed osteonecrosis in both knees during the treatment period.
Intranasal bevacizumab injection is an effective treatment for most of the moderate and severe grades of HHT-associated epistaxis. The duration of the effect of the treatment was variable. Primary and late resistance phenomena to the treatment were quite common.
目的/假设：遗传性出血性毛细血管扩张症（HHT）鼻内注射贝伐单抗的长期随访。
前瞻性、非对照研究。
纳入2011年6月至2013年8月间接受鼻内黏膜下注射贝伐单抗治疗HHT相关性鼻出血的患者，并进行前瞻性随访。通过鼻出血严重程度评分（ESS）、鼻出血强度、频率及输血需求（IFT）评分和血红蛋白水平评估治疗效果。
纳入33例患者。鼻内注射贝伐单抗的治疗总次数为210次。每位患者的平均治疗次数为6.2±4.6次（范围1 - 16次），平均治疗及观察期为38.8±21.8个月（范围2 - 66个月）。4例患者治疗后无改善。11例患者（33.3%）ESS和IFT最初均有改善，但在研究结束前治疗中断，因为尽管反复注射，效果持续时间逐渐缩短。12例患者（36.3%）在研究结束时对治疗仍有阳性反应。未观察到局部不良反应，但1例患者在治疗期间双膝发生骨坏死。
鼻内注射贝伐单抗对大多数中重度HHT相关性鼻出血是一种有效的治疗方法。治疗效果持续时间不一。治疗的原发和迟发抵抗现象相当常见。
4。《喉镜》，128:2237 - 2244，2018年。
