口服普萘洛尔治疗婴幼儿血管瘤中国专家共识（2022版）

doi:10.19438/j.cjoms.2022.04.001

中国口腔颌面外科杂志 ›› 2022, Vol. 20 ›› Issue (4): 313-319.doi: 10.19438/j.cjoms.2022.04.001

口服普萘洛尔治疗婴幼儿血管瘤中国专家共识（2022版）

郑家伟^1,*, 王绪凯^2,*, 秦中平³, 范新东⁴, 李凯⁵, 杨耀武⁶, 霍然⁷, 刘少华⁸, 赵吉宏⁹, 汪小勇¹⁰, 周德凯¹¹, 刘学键¹²

1.上海交通大学医学院附属第九人民医院·口腔医学院口腔颌面-头颈肿瘤科,上海 200011;
2.中国医科大学口腔医学院口腔颌面外科, 辽宁沈阳 110001;
3.山东省临沂市肿瘤医院省A级血管瘤特色专科,山东临沂 276001;
4.上海交通大学医学院附属第九人民医院介入科,上海 200011;
5.复旦大学附属儿科医院外科,上海 201102;
6.空军军医大学口腔医学院头颈肿瘤外科,陕西西安 710032;
7.山东第一医科大学附属省立医院（山东省立医院）烧伤整形美容外科,山东济南 250021;
8.山东大学齐鲁医院口腔颌面外科,山东济南 250012;
9.武汉大学口腔医学院口腔外科,湖北武汉 430079;
10.上海曹安医院血管瘤科,上海 201804;
11.重庆医科大学附属儿童医院胃肠新生儿外科血管瘤专科,重庆 400014;
12.山东省立第三医院两腺与血管瘤科,山东济南 250012

收稿日期:2022-06-01 修回日期:2022-06-15 出版日期:2022-07-20 发布日期:2022-07-20
通讯作者: 王绪凯,E-mail: wangxukai757892@sina.com;郑家伟,E-mail:davidzhengjw@hotmail.com。^*共同通信作者
作者简介:郑家伟(1964-) ,男,博士,教授,博士研究生导师
基金资助:
国家自然科学基金（82071130）

Chinese experts consensus on the use of oral propranolol for treatment of infantile hemangiomas(version 2022)

ZHENG Jia-wei¹, WANG Xu-kai², QIN Zhong-ping³, FAN Xin-dong⁴, LI Kai⁵, YANG Yao-wu⁶, HUO Ran⁷, LIU Shao-hua⁸, ZHAO Ji-hong⁹, WANG Xiao-yong¹⁰, ZHOU De-kai¹¹, LIU Xue-jian¹²

1. Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine. Shanghai 200011;
2. Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University; Liaoning Institute of Dental Research. Shenyang 110001, Liaoning Province;
3. Special Department of Hemangioma, Tumor Hospital of Linyi City. Linyi 276001, Shandong Province;
4. Department of Intervention Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011;
5. Department of Pediatric Surgery, Children's Hospital of Fudan University. Shanghai 201102;
6. Department of Head and Neck Tumor Surgery, School of Stomatology, Air Force Military Medical University. Xi'an 710032, Shaanxi Province;
7. Department of Aesthetic Plastic and Burn Surgery, Shandong Provincial Hospital, Shandong First Medical University. Jinan 250021,Shandong Province;
8. Department of Oral and Maxillofacial Surgery, Qilu Hospital, Shandong University. Jinan 250012,Shandong Province;
9. Department of Oral Surgery, School of Stomatology, Wuhan University. Wuhan 430079, Hubei Province;
10. Department of Infantile Hemangioma, Shanghai Cao'an Hospital. Shanghai 201804;
11. Department of Infantile Hemangioma, Gastrointestinal and Neonatal Surgery, Children's Hospital of Chongqing Medical University. Chongqing 400014;
12. Department of Thyroid Gland, Mammary Gland and Hemangiomas, Shandong Provincial Third Hospital. Jinan 250031, Shandong Province,China

Received:2022-06-01 Revised:2022-06-15 Online:2022-07-20 Published:2022-07-20

摘要/Abstract

摘要： 自2008年以来,普萘洛尔已经成为婴幼儿血管瘤的一线治疗药物。国内外对其治疗机制进行了大量研究,并制定和发布了多个专家共识或临床实践指南。近年来,随着临床经验的不断积累,基础研究工作的逐步深入,对血管瘤发病机制、普萘洛尔作用机制认识的不断加深,有必要对专家共识进行更新,以更加符合临床实际,指导用药和管理,为临床上使用普萘洛尔治疗婴幼儿血管瘤提供科学规范。本更新主要是简化了临床检查、用药、监测流程,使之更具有便利性和可操作性。

关键词: 普萘洛尔, 婴幼儿血管瘤, 专家共识

Abstract: Since 2008, propranolol has become the first-line treatment for infantile hemangiomas. Many researches have been reported on its treatment mechanism both at home and abroad, and several expert consensus or clinical practice guidelines have been formulated and published. In recent years, with the continuous accumulation of clinical experience, increasing number of basic research works, and deepening understanding of the pathogenesis of hemangioma and the mechanism of action of propranolol, it is necessary to update the expert consensus to be more consistent with clinical practice, in order to guide medication and management, provide scientific norms for the clinical use of propranolol in the treatment of infantile hemangiomas. This updated version mainly simplified the process of clinical examination, medication, and monitoring, making it more convenient and operable.

Key words: Propranolol, Infantile hemangioma, Experts consensus

中图分类号:

R739.8

郑家伟, 王绪凯, 秦中平, 范新东, 李凯, 杨耀武, 霍然, 刘少华, 赵吉宏, 汪小勇, 周德凯, 刘学键. 口服普萘洛尔治疗婴幼儿血管瘤中国专家共识（2022版）[J]. 中国口腔颌面外科杂志, 2022, 20(4): 313-319.

ZHENG Jia-wei, WANG Xu-kai, QIN Zhong-ping, FAN Xin-dong, LI Kai, YANG Yao-wu, HUO Ran, LIU Shao-hua, ZHAO Ji-hong, WANG Xiao-yong, ZHOU De-kai, LIU Xue-jian. Chinese experts consensus on the use of oral propranolol for treatment of infantile hemangiomas(version 2022)[J]. China J Oral Maxillofac Surg, 2022, 20(4): 313-319.

参考文献

[1] Kilcline C, Frieden IJ.Infantile hemangiomas: how common are they? a systematic review of the medical literature[J]. Pediatr Dermatol, 2008, 25(2):168-173.
[2] Léauté-Labrèze C, Harper JI, Hoeger PH.Infantile haemangioma[J]. Lancet, 2017, 390(10089):85-94.
[3] Goelz R, Poets CF.Incidence and treatment of infantile haemangioma in preterm infants[J]. Arch Dis Child Fetal Neonatal Ed, 2015,100(1):F85-F91.
[4] 郑家伟. 婴幼儿血管瘤“等待观察”的治疗策略应予改变[J].中国口腔颌面外科杂志,2012, 10(2):163-164.
Zheng JW.Infantile hemangiomas: seldom wait and see[J].China Journal of Oral and Maxillofacial Surgery, 2012, 10(2):163-164.
[5] Liu X, Qu X, Zheng J, et al.Effectiveness and safety of oral propranolol versus other treatments for infantile hemangiomas: a meta-analysis[J]. PLoS One, 2015, 10(9):e0138100.
[6] Léauté-Labrèze C, Dumas de la Roque E, Hubiche T, et al. Propranolol for severe hemangiomas of infancy[J]. N Engl J Med, 2008, 358(24):2649-2651.
[7] Drolet BA, Frommelt PC, Chamlin SL, et al.Initiation and use of propranolol for infantile hemangioma: report of a consensus conference[J]. Pediatrics, 2013, 131(1):128-140.
[8] Hoeger PH, Harper JI, Baselga E, et al.Treatment of infantile haemangiomas: recommendations of a European expert group[J]. Eur J Pediatr, 2015,174(7):855-865.
[9] 秦中平,刘学键,李克雷,等.小剂量普萘洛尔口服治疗婴儿血管瘤的近期疗效与安全性评价[J].中华医学杂志,2009,89(44):3130-3134.
Qin ZP, Liu XJ, Li KL, et al.Treatment of infantile hemangiomas with low-dose propranolol: evaluation of short-term efficacy and safety[J]. Chinese Journal of Medicine, 2009, 89(44):3130-3134.
[10] 郑家伟,王绪凯,秦中平,等.口服普萘洛尔治疗婴幼儿血管瘤中国专家共识[J].上海口腔医学,2016,25(3):257-260.
Zheng JW, Wang XK, Qin ZP, et al.Chinese experts consensus on the use of oral propranolol for treatment of infantile hemangiomas[J]. Shanghai Journal of Stomatology, 2016,25(3):257-260.
[11] 普萘洛尔治疗婴幼儿血管瘤共识专家小组.口服普萘洛尔治疗婴幼儿血管瘤专家共识[J].中华小儿外科杂志,2019,40(10):865-869.
Consensus Expert Panel on Propranolol for the Treatment of Infantile Hemangioma. Consensus on oral propranolol treatment for infantile hemangiomas[J]. Chinese Journal of Pediatric Surgery,2019,40(10):865-869.
[12] 王杞章,郑家伟.口服普萘洛尔治疗婴幼儿增殖期血管瘤:英国儿科皮肤病学会共识及临床指南[J].中国口腔颌面外科杂志,2020,18(6):548-552.
Wang QZ, Zheng JW.Oral propranolol in the treatment of proliferating infantile haemangiomas:British Society for Paediatric Dermatology consensus guidelines(translation version)[J].China Journal of Oral and Maxillofacial Surgery,2020,18(6):548-552.
[13] Storch CH, Hoeger PH.Propranolol for infantile haemangiomas: insights into the molecular mechanisms of action[J]. Br J Dermatol, 2010, 163(2):269-274.
[14] Ji Y, Chen S, Xu C, et al.The use of propranolol in the treatment of infantile haemangiomas: an update on potential mechanisms of action[J]. Br J Dermatol,2015,172(1):24-32.
[15] Kleinman ME, Greives MR, Churgin SS, et al.Hypoxia induced mediators of stem/progenitor cell trafficking are increased in children with hemangioma[J]. Arterioscler Thromb Vasc Biol, 2007, 27(12):2664-2670.
[16] Kum JJ, Khan ZA.Mechanisms of propranolol action in infantile hemangioma[J]. Dermatoendocrinol, 2015, 6(1):e979699.
[17] Stiles J, Amaya C, Pham R, et al.Propranolol treatment of infantile hemangioma endothelial cells: a molecular analysis[J]. Exp Ther Med,2012,4(4):594-604.
[18] Kowalska M, Debek W, Matuszczak E.Infantile hemangiomas: an update on pathogenesis and treatment[J]. J Clin Med, 2021, 10(20):4631.
[19] 盐酸普萘洛尔口服溶液说明书[Z/OL].2021-06-25.http://www.propranolol-solution.com/col.jsp?id=121.
Instructions for propranolol hydrochloride oral solution[Z/OL].2021-06-25.http://www.propranolol-solution.com/col.jsp?id=121.
[20] 郑家伟,张凌,陈正岗.普萘洛尔治疗婴幼儿血管瘤专家共识[J].中国口腔颌面外科杂志, 2013,11(2):161-164.
Zheng JW, Zhang L, Chen ZG.Introduction to a consensus conference on the use of propranolol for infantile hemangioma[J]. China Journal of Oral and Maxillofacial Surgery, 2013,11(2):161-164.
[21] Smithson SL, Rademaker M, Adams S, et al.Consensus statement for the treatment of infantile haemangiomas with propranolol[J]. Australas J Dermatol, 2017,58(2):155-159.
[22] Caussé S, Aubert H, Saint-Jean M, et al.Propranolol-resistant infantile haemangiomas[J]. Br J Dermatol, 2013, 169(1):125-129.
[23] Liu C, Zhao Z, Wu H, et al.Effect of combined low-dose oral prednisone with beta-adrenergic receptor antagonists for refractory infantile hemangiomas: retrospective cohort study in 76 patients[J]. Ann Transl Med, 2019, 7(23):750.
[24] Sebaratnam D, Rodríguez Bandera AI, Wong LF, et al.Infantile hemangioma. part 2: management[J]. Am Acad Dermatol, 2021, 85(6):1395-1404.
[25] Tan ST, Itinteang T, Leadbitter P.Low dose propranolol for infantile haemangioma[J]. J Plast Reconstr Aesthet Surg, 2011,64(3):292-299.
[26] Siegfried EC, Keenan WJ, Al-Jureidini S.More on propranolol for hemangiomas of infancy[J]. N Engl J Med, 2008, 359(26):2846.
[27] Rangno RE, Nattel S, Lutterodt A.Prevention of propranolol withdrawal mechanism by prolonged small dose propranolol schedule[J]. Am J Cardiol, 1982, 49(4):828-833.
[28] Shah SD, Baselga E, McCuaig C, et al. Rebound growth of infantile hemangiomas after propranolol therapy[J]. Pediatrics, 2016,137(4):e20151754.
[29] 中华医学会整形外科分会血管瘤和脉管畸形学组.血管瘤和脉管畸形的诊断及治疗指南(2019版)[J].组织工程与重建外科杂志,2019,15(5):277-317.
Chinese Medical Association plastic Surgery branch hemangioma and vascular malformation group. CSSVA guidelines for vascular snomalies 2019[J].Journal of Tissue Engineering and Reconstructive Surgery,2019,15(5):277-317.
[30] Love JN, Sikka N.Are 1-2 tablets dangerous? beta-blocker exposure in toddlers[J]. J Emerg Med, 2004,26(3):309-314.
[31] Cushing SL, Boucek RJ, Manning SC, et al, Initial experience with a multidisciplinary strategy for initiation of propranolol therapy for infantile hemangiomas[J]. Otolaryngol Head Neck Surg,2011,144(1):78-84.
[32] Zhao ZL, Liu C, Zheng JW, et al.Oral atenolol treatment for infantile hemangiomas: clinical analysis of 133 consecutive patients[J]. Ann Transl Med, 2021, 9(2):116.
[33] 王琦,向波,吉毅,等.普萘洛尔与阿替洛尔治疗婴儿血管瘤的比较研究[J].中华皮肤科杂志,2016, 49(10):683-687.
Wang Q, Xiang B, Ji Y, et al.Propranolol versus atenolol in the treatment of infantile hemangioma:a comparative study[J]. Chinese Journal of Dermatology, 2016, 49(10):683-687.
[34] Pope E, Lara-Corrales I, Sibbald C, et al.Noninferiority and safety of nadolol vs propranolol in infants with infantile hemangioma: a randomized clinical trial[J]. JAMA Pediatr, 2022, 176(1):34-41.
[35] Laurens C, Abot A, Delarue A, et al.Central effects of beta-blockers may be due to oxide and hydrogen peroxide release independently of their ability to cross the blood-brain barrier[J]. Front Neurosci, 2019,13:33.
[36] 宫贺,徐大朋,李越霄,等.0.5%马来酸噻吗洛尔滴眼液联合普萘洛尔治疗婴幼儿血管瘤疗效分析[J].中国口腔颌面外科杂志,2014,12(5):441-445.
Gong H, Xu DP, Li XY, et al.Topical timolol maleate 0.5% ophthalmic solution combined with propranolol in the management of infantile hemangiomas[J]. China Journal of Oral and Maxillofacial Surgery, 2014, 12(5):441-445.
[37] Li G, Xu D, Tong S, et al.Oral propranolol with topical timolol maleate therapy for mixed infantile hemangiomas in oral and maxillofacial regions[J]. J Craniofac Surg, 2015, 53(9):836-840.
[38] Wu HW, Liu C, Wang X, et al.Topical application of 0.5% timolol maleate hydrogel for the treatment of superficial infantile hemangioma[J]. Front Oncol, 2017, 7:137.

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[14]	顾达, 霍然, 徐广琪, 毕见海, 李尚滨. 局部外用β受体阻滞剂治疗婴幼儿血管瘤的临床应用研究进展[J]. 中国口腔颌面外科杂志, 2020, 18(4): 375-380.
[15]	鞠侯雨, 郑家伟, 孙沫逸, 唐瞻贵, 杨道科, 冉炜, 步荣发, 尚伟, 孟箭, 武和明, 席庆, 杨凯, 王军, 邹建明, 吴云腾, 任国欣, 郭伟. 口腔颌面头颈部鳞癌超声热化疗中国专家共识[J]. 中国口腔颌面外科杂志, 2020, 18(3): 193-198.

口服普萘洛尔治疗婴幼儿血管瘤中国专家共识（2022版）

Chinese experts consensus on the use of oral propranolol for treatment of infantile hemangiomas(version 2022)

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