Department of Otolaryngology Head & Neck Surgery, 2538Monash Health, Melbourne, Australia.
Department of Surgery, 2541Monash University, Melbourne, Australia.
Am J Rhinol Allergy. 2022 Nov;36(6):890-896. doi: 10.1177/19458924221118131. Epub 2022 Aug 4.
Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease affecting 1 in 5000 individuals. Epistaxis is seen in more than 90% of patients with HHT. Severe recurrent epistaxis can significantly decrease quality of life and may be resistant to standard treatment measures. Dysregulation of angiogenesis has been shown to cause the proliferation of abnormal blood vessels. As such, antiangiogenic treatments have been investigated including beta-blockers.
A systematic review of the efficacy of beta-blockers in topical treatment of epistaxis in patients with HHT based on epistaxis duration, frequency, and severity.
A systematic search was performed using the PubMed, Embase via Ovid, and Cochrane databases. The Preferred Items for Systematic Reviews and Meta-Analyses guidelines were followed. Studies that measured the efficacy of beta-blocker treatment of epistaxis in patients with HHT were included for qualitative analysis.
Five studies (3 randomized controlled trials and 2 case series) with a total of 132 patients were included. Administration (systemically or topically via a spray or gel) of timolol and propranolol showed mixed evidence of improvement in epistaxis frequency, severity, and duration when compared with control groups. The evidence for propranolol appears more promising than timolol.
There are significant limitations in the included studies, and further investigation with larger longitudinal or randomized prospective trials is recommended. The available evidence suggests that beta-blocker treatment may have a positive effect on HHT-related epistaxis.
遗传性出血性毛细血管扩张症（HHT）是一种常染色体显性遗传疾病，影响每 5000 人中的 1 人。90%以上的 HHT 患者有鼻出血。严重的复发性鼻出血会显著降低生活质量，并且可能对标准治疗措施产生抗性。血管生成失调已被证明会导致异常血管的增殖。因此，已经研究了包括β受体阻滞剂在内的抗血管生成治疗。
基于鼻出血持续时间、频率和严重程度，对β受体阻滞剂局部治疗 HHT 患者鼻出血的疗效进行系统评价。
使用 PubMed、Embase via Ovid 和 Cochrane 数据库进行系统搜索。遵循系统评价和荟萃分析的首选项目指南。纳入了测量β受体阻滞剂治疗 HHT 患者鼻出血疗效的研究进行定性分析。
共纳入了 5 项研究（3 项随机对照试验和 2 项病例系列研究），共 132 名患者。与对照组相比，全身性或通过喷雾或凝胶局部给予噻吗洛尔和普萘洛尔显示出混合改善鼻出血频率、严重程度和持续时间的证据。普萘洛尔的证据似乎比噻吗洛尔更有希望。
纳入研究存在重大局限性，建议进行更大规模的纵向或随机前瞻性试验进一步研究。现有证据表明，β受体阻滞剂治疗可能对 HHT 相关的鼻出血有积极影响。
