| Research backgroundInfantile hemangioma(IH)is a rapidly proliferating benign tumor of the skin and soft tissue in childhood.The incidence of IH can reach 8%to 10%,and it is more common in women.Although part of IH can subside by itself,red scars,pigmentation and telangiectasia will be left on local skin after subtraction,and facial deformities will result from growth in the head,neck and face,all of which need timely treatment.At present,the first-line treatment drug is propranolol,but its curative effect is not consistent at home and abroad,and some patients still have poor curative effect.There are literature describing that other drugs can be used for treatment of propranolol ineffective,and there are other drugs and therapeutic programs with good clinical effect,but there is no consensus on the clinical characteristics of ineffective patients and possiblealternative programs.Objective:1.To analyze the effects of age,gender,tumor site,tumor number,tumor type and tumor volume on the therapeutic effect of oral propranolol on infantile hemangioma,and to promptly adopt individualized treatment plan for poor therapeutic effect,so as to facilitate the judgment ofprognosis and communication between doctors and patients.2.Meta analysis was conducted to compare the efficacy and safety of propranolol and other drugs(hormone,atenolol,timolol,propranolol combined with other drugs)in the treatment of infantile hemangioma,so as to provide reference for the precise treatment of infantilehemangioma.Methods:1.Clinical medical records of children with infantile hemangioma treated by oral propranolol in pediatric surgery department of our hospital from June 2019 to April 2022 were collected,including patients’age,gender,tumor site,tumor volume,single or multiple tumor,tumor type,as well as side effects during medication,and recorded in detail.The efficacy and safety of the treatment were evaluated and divided into effective group and poor effect group.SPSStest was used to analyze the factors affecting the therapeuticeffect of the two groups.2.Use computer to search Chinese databases:CNKI database,Chongqing VIP Journal Database,Wanfang Academic Journal Database,etc.;English databases:Pubmed,Cochrane Library,Embase database,etc.By combining subject words with free words,For example,"infantile hemangioma""propranolol AND timolol""propranolol AND tiolol""Propranolol AND teolol""Propranolol AND hormone""Propranolol AND timolol""Propranolol AND atenolol""propranolol AND atenolol""propranolol AND steroids or corticosteroid""propranolol AND combination""infantile hemangioma",retrieval time from the establishment of the database till now.Meta-analysis was performed using Revman5.4 software,and statistical heterogeneity among literatures was tested by I~2.If I~2<50%,it indicated low heterogeneity among the literatures,then fixed effect model was used for calculation and pooled analysis.If I~2≥50%,the random effects model is selected for calculation and combined analysis.95%confidence interval(CI)and odds ratio(OR)were used to analyze the efficacy and side effects.95%confidenceinterval was used forinterval estimation of research indicators,and P<0.05 indicated that thedifference was statistically significant.Results:1.Retrospective study of 145 children with IH showed that 107 children with IH had good therapeutic effect and 38 children with IH had poor therapeutic effect,with good effect accounting for 73.8%and poor effect accounting for 26.2%.The effective rates were 75.5%,71.4%and 64.3%forthe patients aged 0-6 months,June-9 months and>9months,respectively;the effective rates for male and female children were 69.0%and 76%;the effective rates for head and neck,face,limbs and trunk were 80%,75.8%and 64.5%,respectively.The effective rates of single and multiple cases were 75.6%and 65.4%,and there were no significant differences in age,gender,tumor location and tumor number(P>0.05).Different tumor volume showed significant difference in efficacy(P=0.002<0.05),and the volume of children who failed treatment was larger.The effective rates of superficial type,deep type and mixed type were 84.1%,71.4%and 60.4%,respectively.There was a statistical difference in the therapeuticeffect of tumor type(P<0.05).2.A total of 30 literatures were included in this study,involving a total of 3493 infantile hemangioma patients.Intervention drugs included propranolol,atenolol,hormone,timolol and propranolol combined with other drugs.Among the 30 literatures,14 were randomized controlled trial(RCT),16 were controlled clinical trial(CCT),and9 were comparative analyses of the efficacy andsafety of propranolol and hormonein the treatment of infantile hemangioma.Results showed that propranolol was more effective than hormone(OR:4.47,95%CI[2.93,6.82],P<0.00001),and side effects were less common(OR:0.08,95%CI[0.04,0.19],P<0.00001).There were 7 studies comparing the efficacy and safety of propranolol and atenolol in the treatment of infantile hemangioma,and the results showed that there was no significant difference in the efficacy between propranolol and atenolol(OR:1.22,95%CI[0.86,1.73],P=0.27>0.05).However,side effects of propranolol were more common(OR:2.78,95%CI[2.17,3.56],P<0.00001)and central nervous system side effects were more common than atenolol.There were 5 studies on the comparative analysis of the efficacy and safety of propranolol and timolol in the treatment of infantile hemangioma,and the results showed that there was no significant difference in the efficacy of propranolol and timolol.(OR:1.05,95%CI[0.78,1.43],P=0.74>0.05).However,side effects of propranolol were more common(OR:3.49,95%CI[1.08,11.31],P=0.04<0.05);There were 9 studies on the comparative analysis of the efficacy and safety of propranolol alone and propranolol combined with other drugs in the treatment of infantile hemangioma,the results showed that the combined treatment had better efficacy(OR:0.20,95%CI[0.12,0.32],P<00001),and the efficacy of grade IV(excellent)efficacy was better(OR:0.20,95%CI[0.12,0.32],P<00001),but therewas no significant difference insideeffects(OR:1.22,95%CI[0.70,2.14],P=0.48>0.05).Conclusion:1.Oral propranolol had good clinical effect(73.8%)and poor clinical effect(26.2%)in the treatment of infantile hemangioma;There was no significant difference in the efficacy of propranolol in the treatment of infantile hemangioma in different parts of tumor,different numbers,different ages and different genders.Mixed type and IH with a large volume(>20cm~3)suggest poor clinical efficacy,such children can inform their families of the differenceinprognosis inadvance,and timely individualized treatment.2.Meta-analysis showed that the overall efficacy and safety of propranolol were higher than that of hormone.The combination of propranolol may be more effective than propranolol alone.The efficacy of topical timolol and atenolol is similar to that of propranolol for IH,but theincidenceof side effects is lower.3.Meta-analysis suggested that atenolol could reduce central nervous system side effects,andatenolol could be used totreat IH patients who could not tolerate sideeffects of propranolol.Topical timolol can be preferred for superficial infantile hemangioma,which has high effectiveness and low systemic side effects.Propranolol combined with timolol or tumor injection has better therapeutic effect,and Grade IV(excellent)efficacy is higher than propranolol alone,so it can improve the therapeutic effect,but combined use of the same drug class should be avoided.Different treatment methods and combination therapy should be combinedwith case analysis. |
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