Serum concentrations of VEGF and bFGF in the course of propranolol therapy of infantile hemangioma in children: Are we closer to understand the mechanism of action of propranolol on hemangiomas?
Serum concentrations of VEGF and bFGF in the course of propranolol therapy of infantile hemangioma in children: Are we closer to understand the mechanism of action of propranolol on hemangiomas?
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DOI：
10.17219/acem/84800
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发表时间：
2018-05-01
影响因子：
2.1
通讯作者：
Baglaj, Maciej
中科院分区：
文献类型：
--
作者：
Babiak-Choroszczak, Lidia;Gizewska-Kacprzak, Kaja;Baglaj, Maciej
背景。心得安已成为治疗婴幼儿血管瘤（IH）的首选。IH的发病机制和心得安对其的作用机制尚不清楚。可能的解释包括通过降低血管内皮生长因子（VEGF）和碱性成纤维细胞生长因子（bFGF）抑制血管生成，诱导血管内皮细胞凋亡和血管收缩。本研究的目的是评估在普萘洛尔治疗IH儿童过程中血清中VEGF和bFGF的浓度，并评估其临床意义。材料和方法。该研究包括51名接受心得安治疗的IH患儿。在治疗前、治疗中和治疗后对参与者进行血管瘤活动评分（HAS）、病变多普勒超声（US）以及VEGF和bFGF血清浓度的评估。所有儿童均表现出HAS测量的临床改善。在决定逐渐停用心得安时，32名（63%）儿童的IH完全消退；在治疗结束时，28名（61%）患者的IH完全消退（46名患者在1.5个月后随访）。随访时多普勒超声显示24例（52%）患儿病变血流完全消失，12例（26%）患儿血流减少。与治疗前相比，治疗期间和治疗后VEGF和bFGF均显著降低。多普勒超声结果与治疗期间和治疗后bFGF的变化有相关性。治疗期间VEGF的变化与多普勒超声的变化无关。在心得安治疗IH期间，血清VEGF和bFGF浓度下降，这可能表明心得安对两者都有影响。然而，统计分析显示它们作为心得安治疗的生化指标的预后价值较低。临床评价结合多普勒超声是监测治疗的最有价值的方法。
Background. Propranolol has become the treatment of choice for infantile hemangiomas (IH). Neither the pathogenesis of IH nor the mechanism of action of propranolol on them are well understood. Possible explanations include the inhibition of angiogenesis by decreasing vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF), induction of vascular endothelial cell apoptosis and vasoconstriction.Objectives. The aim of the study was to assess serum concentrations of VEGF and bFGF in the course of propranolol therapy of IH in children, and to assess their clinical implications.Material and methods. The study included 51 children with IH treated with propranolol. The participants were assessed before, during and after the therapy with Hemangioma Activity Score (HAS), Doppler ultrasound (US) of the lesions, as well as VEGF and bFGF serum concentrations.Results. All children showed clinical improvement measured in the HAS. A complete involution of the IH was reported in 32 (63%) children at the time of decision of the gradual withdrawing of propranolol, and in 28 (61%) patients at the end of the treatment (out of 46 patients present at the follow up after 1.5 months). Doppler US at the follow-up showed a complete disappearance of the blood flow in the lesion in 24 (52%) children and its reduction in 12 (26%) children. There was a significant decrease in VEGF and bFGF during and after treatment compared to pretreatment values. There was a correlation between the outcome of the Doppler US and changes in bFGF during and after treatment. Changes in VEGF during treatment did not correlate with changes in the Doppler US.Conclusions. Serum concentrations of VEGF and bFGF decreased during the propranolol treatment of IH, which may indicate the effect of propranolol on both. However, the statistical analysis showed their low prognostic value as biochemical markers of propranolol treatment. Clinical evaluation combined with Doppler US is the most valuable method of monitoring the therapy.