Safety Of Oral Propranolol Combined With Local Sclerotherapy In Treating Infantile Hemangioma

Background:Infantile hemangioma is a common benign vascular tumor of infants and young children,and its incidence rate is between 4%and 5%.It is a self-limited disease.Proliferating tumors grow rapidly.Without intervention,they may cause complications such as ulceration,infection,and even endanger patient's life in severe cases.Therefore,some patients need active treatment which can prevent permanent appearance deformities or serious complications.Oral propranolol and injection of lauromacrogol and triamcinolone are common therapeutic methods for infantile hemangioma.The curative effect of oral propranolol combined with intralesional injection of lauromacrogol and triamcinolone has been proven,and it is superior to monotherapy to a certain extent.However,there is no clinical research to explore the safety of this combination therapy.Objective:The study aims to analyze the adverse reactions of oral propranolol combined with intralesional injection of lauromacrogol and triamcinolone acetonide in the treatment of infantile hemangioma,and its effects on the height and weight of patients,so as to provide some ideas for clinical treatment.Methods:A total of 634 cases with infantile hemangioma who received the above combination therapy from January 2015 to May 2018 were collected in the retrospective analysis.Analyze and record the occurrence of adverse reactions and the basic information of the patients in detail.The height and weight of the patients at the age of 24 months were recorded.The patients were grouped according to gender,time of oral propranolol,and number of sclerosis treatments.SPSS 20.0 was used for statistical analysis.Wilcoxon nonparametric rank sum test was used to compare the height and weight of the above groups with the reference standards for the growth and development of children under 7 years old in China.Kruskal-Wallis rank sum test was used for the comparison among groups.Results:Among the 634 cases,165 were male and 469 were female.The ratio of male to female was 1:2.84.The time of oral propranolol is between 0.07-14 months.The number of injections ranges from 1-12.135(21.29%)experienced adverse reactions.Among them,106 cases(16.72%)related to propranolol,and serious adverse reactions were found including shortness of breath(0.16%),bloody stools(0.16%),severe diarrhea(0.16%)and hypoglycemia(0.16%).54 cases(8.52%)related to intralesional injection of lauromacrogol and triamcinolone,and no serious adverse reactions were found.There was no statistically significant difference in median height and weight compared with the reference standards,regardless of sex(P>0.05).The median weight level of the girls' oral propranolol 1-5 months group was lower than the reference standard(P=0.013).The median height level of the boys' sclerosis treatment 4-6 times group was higher than the reference standard(P=0.008).The average height of the boys' sclerosis treatment?7 times group was higher than that of the 1-3 times group(P=0.031).There was no statistically significant difference between the other groups compared with the reference standard and between groups(P>0.05).Conclusion:Oral propranolol combined with intralesional injection of lauromacrogol and triamcinolone is a safe and effective method for treating infantile hemangioma.Among 634 patients,135(21.29%)experienced adverse reactions.The incidence of serious adverse reactions was 0.63%.When the dose of propranolol,lauromacrogol and triamcinolone is less than 2.0 mg/kg/d,3.5 mg/kg and 2.0 mg/kg respectively,the above combined treatment has no significant effect on the height and weight of patients at the age of 24 months.