Efficiency Analysis Of Drug Therapy Of Infantile Hemangiomas

BackgroundHemangioma is a common and frequently-occurring disease in children,and infantile hemangioma(IH)has the highest incidence.The lesion of IH is often located on exposed parts of skin such as face and limbs,which affects patient's appearance.In some cases,the lesion may involve or compress important organs to affect the function of organs.For reasons of less trauma,economy,convenience and good efficacy,drug therapy is widely accepted by patients and their families.However,blindly choosing one or several drugs for IH treatment without considering individual conditions may result in serious consequences such as drug abuse,delay of patient's condition and higher disfigurement risk.Objective1.To deepen the understanding of IH.2.To provide basis for optimizing the diagnosis and treatment of IH.Methods1.Collection of patientsBy searching the electronic medical record system,we collected hemangioma patients who were admitted to our department from February 2015 to August 2017 and regularly followed up,and appropriate patients were selected as subjects according to inclusion criteria.The age,gender,adverse events during pregnancy,gestational age at birth,onset age,age at visit,clinical manifestation,imaging examination,therapeutic method,course of treatment,treatment response and adverse events of included patients were recorded.2.Typing and classification of subjectsHemangioma was typed and classified based on clinical manifestation,imaging data and pathological data.According to the grading system in Guidelines for Diagnosis and Treatment of Hemangioma and Vascular Malformation,IH was classified into three grades:low risk,moderate risk and high risk.3.Grades of efficacy(1)Grade ?:The response to treatment was poor,and the reduction in tumor size was<25%;(2)Grade ?:The response to treatment was moderate,and the reduction in tumor size was>25%and<50%;(3)Grade ?:The response to treatment was good,and the reduction in tumor size was>50%and<75%;(4)Grade ?:The response to treatment was excellent,and the reduction in tumor size was>76%.Grade ? and grade ? were partial response(PR)cases,and grade ? and grade ?were good response(GR)cases.4.Evaluation criteria for adverse eventsNCI-CTCAE 4.0 was used for evaluation.5.Data analysis methodsSPSS 21.0 software was used for statistical analysis.Measurement data were expressed as mean±SD(x±s),and t test was used for the comparison of inter-group difference;enumeration data were expressed as number of cases(n)and percentage[n(%)],and chi-squared test or Fisher's exact test was used for the comparison of inter-group difference.P<0.05 was considered statistically significant.For efficacy,significance level was corrected after paired comparison,and P<0.017 was considered statistically significant.Result1.General dataA total of 158 hemangioma children were included in the study,with 79 males and 78 females,and the male/female ratio was 1.01:1.The average onset age was 25.06 days.Hemangioma was found in 147 cases(93.03%)within one month after birth.The average age at visit was 5.47 months,and 99 cases(62.66%)were 0-3 months at visit.2.Location of hemangiomaFor the location of hemangioma,63 cases(39.87%)were on head and neck,50 cases(31.65%)were on trunk,38 cases(24.05%)were on limbs,3 cases(1.90%)were on head-trunk,1 case(0.06%)was on head-limbs,and 3 cases(1.90%)were on trunk-limbs.3.Type and classification(1)Classification of IH:There were 103 cases(65.19%)of superficial IH,35 cases(22.15%)of deep IH,and 20 cases(12.66%)of mixed IH.(2)Type of IH:There were 138 cases(87.34%)of solitary IH,15 cases(9.49%)of multiple IH,3 cases(1.90%)of segmental IH,and 2 cases(1.27%)of intermediate IH.(3)Risk grade of IH:There were 31 cases(19.62%)of low risk,52 cases(32.91%)of moderate risk,and 75 cases(47.47%)of high risk.4.Efficacy and adverse reactions(1)Grade of efficacy:There were 3 cases(1.90%)of grade ?,26 cases(16.46%)of grade ?,70 cases(44.30%)of grade ?,and 59 cases(37.34%)of grade ?.The GR(grade ? + grade ?)rate was 81.64%.(2)Drug therapies for superficial IH children were mainly oral administration of propranolol,external use of imiquimod,and oral administration of propranolol in combination with external use of imiquimod.Statistical analysis showed that the efficacy of combined medication group had no statistically significant difference compared with that of propranolol oral administration group(P>0.05),but the efficacy of two groups was better than that of simple imiquimod external use group(P<0.017),and the treatment course of combined medication group was shorter than that of propranolol oral administration group and imiquimod external use group(P<0.05).(3)Therapies for deep and mixed IH children were mainly oral administration of propranolol,intratumoral injection of triamcinolone acetonide and bleomycin,and oral administration of propranolol in combination with intratumoral injection of triamcinolone acetonide and bleomycin.Statistical analysis showed that the results of deep and mixed IH were basically consistent:oral administration of propranolol in combination with intratumoral injection of triamcinolone acetonide and bleomycin had no statistically significant difference compared with simple propranolol oral administration group in efficacy(P>0.05),but had better efficacy compared with intratumoral injection of triamcinolone acetonide and bleomycin(P<0.017).The treatment course of combined medication group had no statistically significant difference compared with that of simple propranolol oral administration group(P>0.05).(4)The main adverse reaction of propranolol oral administration was less sleep,that of imiquimod external use was redness and ulceration of local skin,and that of triamcinolone acetonide and bleomycin local injection was ulceration of injection site.All the adverse reactions were slight,and no adverse reactions above grade II were observed.Conclusion1.IH is the most common in infants aged below 1 year.The lesion can be found in about half of patients at birth.The peak age at visit was 0-3 months.2.Superficial IH is the most common,and lesion of IH is mostly solitary and located on head or face.3.Drug therapy has good efficacy for IH,with slight adverse reaction.3.Propranolol is the first-line treatment for infantile hemangiomas,with good therapeutic effects and mild adverse reactions.And single oral administration can achieve good results.4.For superficial IH,the curative effect of imiquimod monotherapy is relatively poorer than that of oral propranolol,and the duration of treatment is also longer,but there is no other systemic adverse reactions outside the skin.It can be used in low-risk,superficial,and small tumorous infantile hemangiomas;and combined with propranolol can shorten the course of treatment.5.For deep and mixed IH,intratumoral injection of triamcinolone acetonide and bleomycin can be used as a supplemental therapy on the basis of propranolol.7.Appropriate treatment should be chosen based on the classification,type and risk of IH,so as to avoid delay of treatment or overtreatment.