Effect of combined low-dose oral prednisone with beta-adrenergic receptor antagonists for refractory infantile hemangiomas: retrospective cohort study in 76 patients.
Effect of combined low-dose oral prednisone with beta-adrenergic receptor antagonists for refractory infantile hemangiomas: retrospective cohort study in 76 patients.
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DOI：
10.21037/atm.2019.11.94
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发表时间：
2019-10
影响因子：
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通讯作者：
Chao Liu;Zeliang Zhao;H. Wu;Jia-wei Zheng;Yan-an Wang;Xue-jian Liu;X. Fan
中科院分区：
文献类型：
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作者：
Chao Liu;Zeliang Zhao;H. Wu;Jia-wei Zheng;Yan-an Wang;Xue-jian Liu;X. Fan
背景 β-肾上腺素能受体拮抗剂已成为婴儿血管瘤 (IH) 的一线治疗方法；然而，单一疗法对于某些患者可能无法达到足够的疗效，特别是对于难治性 IH。本研究的目的是评估泼尼松和 β-肾上腺素能受体拮抗剂联合治疗难治性 IH 的有效性和安全性。方法 我们研究了 76 名难治性 IH 患者。经过一个多月的口服普萘洛尔治疗不足后，44 名患者接受了泼尼松的额外治疗，而 32 名患者继续接受 β-肾上腺素能受体拮抗剂单药治疗。根据血管瘤评分值评估对治疗的反应。结果联合治疗后患者的预后明显优于β-肾上腺素能受体拮抗剂单药治疗的患者。开始使用泼尼松的年龄与联合治疗组的改善呈显着负相关。两组患者开始治疗时的年龄均与评分变异百分比显着相关。两组之间观察到的治疗持续时间没有显着差异。对所有患者的多变量逻辑回归分析显示，泼尼松给药是改善总体结果的最重要因素。结论 短期加用小剂量口服泼尼松是口服普萘洛尔治疗难治性 IH 的有效且安全的辅助治疗方法。早期给药和足够长的持续时间都是必要的。
Background Beta-adrenergic receptor antagonists have been the first-line treatment for infantile hemangiomas (IHs); however, monotherapy may fail to achieve sufficient efficacy for certain patients, especially for refractory IHs. The aim of this study was to evaluate the efficacy and safety of the combination of prednisone and beta-adrenergic receptor antagonists for refractory IHs. Methods We studied 76 patients with refractory IHs. After more than one month of insufficient oral propranolol therapy, forty-four patients received additional treatment of prednisone, while thirty-two patients continued to receive beta-adrenergic receptor antagonists monotherapy. The response to treatment was assessed according to hemangioma score values. Results The outcomes of patients after combined treatment were significantly better than those with monotherapy of beta-adrenergic receptor antagonists. The age to initiate prednisone was significantly negatively correlated with the improvement in the combination treatment group. The age at initiate treatment showed significant correlation with score variation percentage in both groups. There was no significant difference in the treatment duration observed between the two groups. Multivariable logistic regression analysis for all patients showed prednisone administration was the most important factor to better overall outcomes. Conclusions Short-term addition of low-dose oral prednisone is an effective and safe adjunctive treatment for oral propranolol in contributing to refractory IH. Both early administration and long enough duration would be necessary.