CAJ | 학술논문

目的：系统评价β受体阻滞剂（β-R）治疗婴幼儿血管瘤有效性和安全性。方法计算机检索Cochrane图书馆、PubMed、EMBASE、Web of Science、中国生物医学文献数据库、中国知网、维普数据库，收集β-R治疗婴幼儿血管瘤的RCT文献，检索时限为建库至2014年11月。由2位研究者按照纳入与排除标准筛选文献，提取数据和评价纳入文献的方法学质量，采用RevMan 5.3软件进行Meta分析。结果17篇RCT进入Meta分析，共纳入1097例患儿（β-R组585例，对照组512例）。①普萘洛尔治疗有效率高于泼尼松（ OR=6.15，95%CI：1.69~22.40，P=0.006）；低于激光（ OR =0.13，95%CI：0.02~0.67，P=0.02）；高于 Sr-Y敷贴、维生素 E、安慰剂等其他干预措施（ OR=22.64，95%CI：9.16~55.96，P<0.00001）；与噻吗洛尔治疗有效率差异无统计学意义（ OR=0.64，95%CI：0.31~1.35，P=0.24）。②噻吗洛尔+激光治疗有效率与激光差异无统计学意义（ OR=1.80，95%CI：0.14~23.37，P=0.65）；噻吗洛尔有效率高于空白对照（ OR=21.80，95%CI：7.10~66.90，P<0.05）。③普萘洛尔与其他干预措施（ Sr-Y敷贴、维生素E、安慰剂）的总体不良事件发生率差异无统计学意义（ OR =2.10，95%CI；0.67~6.58，P =0.20），普萘洛尔的不良事件发生率低于泼尼松（OR=0.20，95%CI：0.06~0.65，P=0.007）；高于噻吗洛尔（OR=5.74，95%CI：2.30~14.36，P=0.0002）。β-R对患儿的心率、甲状腺功能及肝肾功能无明显影响。结论β-R治疗婴幼儿血管瘤疗效优于传统的泼尼松，不良事件发生率低于泼尼松。在不同的β-R中，噻吗洛尔体现出与普萘洛尔相近的疗效和较低不良反应的趋向，有待补充研究证实。
목적：계통평개β수체조체제（β-R）치료영유인혈관류유효성화안전성。방법계산궤검색Cochrane도서관、PubMed、EMBASE、Web of Science、중국생물의학문헌수거고、중국지망、유보수거고，수집β-R치료영유인혈관류적RCT문헌，검색시한위건고지2014년11월。유2위연구자안조납입여배제표준사선문헌，제취수거화평개납입문헌적방법학질량，채용RevMan 5.3연건진행Meta분석。결과17편RCT진입Meta분석，공납입1097례환인（β-R조585례，대조조512례）。①보내락이치료유효솔고우발니송（ OR=6.15，95%CI：1.69~22.40，P=0.006）；저우격광（ OR =0.13，95%CI：0.02~0.67，P=0.02）；고우 Sr-Y부첩、유생소 E、안위제등기타간예조시（ OR=22.64，95%CI：9.16~55.96，P<0.00001）；여새마락이치료유효솔차이무통계학의의（ OR=0.64，95%CI：0.31~1.35，P=0.24）。②새마락이+격광치료유효솔여격광차이무통계학의의（ OR=1.80，95%CI：0.14~23.37，P=0.65）；새마락이유효솔고우공백대조（ OR=21.80，95%CI：7.10~66.90，P<0.05）。③보내락이여기타간예조시（ Sr-Y부첩、유생소E、안위제）적총체불량사건발생솔차이무통계학의의（ OR =2.10，95%CI；0.67~6.58，P =0.20），보내락이적불량사건발생솔저우발니송（OR=0.20，95%CI：0.06~0.65，P=0.007）；고우새마락이（OR=5.74，95%CI：2.30~14.36，P=0.0002）。β-R대환인적심솔、갑상선공능급간신공능무명현영향。결론β-R치료영유인혈관류료효우우전통적발니송，불량사건발생솔저우발니송。재불동적β-R중，새마락이체현출여보내락이상근적료효화교저불량반응적추향，유대보충연구증실。
Objective To systematically evaluate the effectiveness and safety of beta-receptor blocker(β-R ) for infantile hemangiomas treatment. Methods Online databases of Cochrane library,PubMed,EMBASE,Web of Science Chinese biomedical literature database( CBM ),CNKI and VIP were comprehensively searched for relevant randomized controlled trials( RCTs ). Quality assessment was conducted by 6 items proposed by Cochrance handbook and data were analyzed by using RevMan 5. 3 software. Results A total of 17 RCTs with 1 097 patients were included( treatment group:585 cases,control group:512 cases). Meta-analysis result showed that propranolol was better than prednisone(OR=6. 15,95%CI:1. 69 _22. 40),worse than laser (OR=0. 13,95%CI:0. 02_0. 67),while had no significant difference with timolol(OR=0. 64,95%CI:0. 31_1. 35). The efficacy of timolol did not differ from propranolo(OR=1. 80,95%CI:0. 14_23. 37,P=0. 65)and higher than that in no treatment (OR=21. 80,95%CI:7. 10 _66. 90,P <0. 05). β-R also had advantages in aspects of onset time,tumor shape and color changing time. For safety,β-R did not cause additional complications of thyroid,liver and kidney,in which propranolol had less complications than prednisone(OR=0. 20,95%CI:0. 06~0. 65),while more complications than timolol(OR=5. 74,95%CI:2. 30 _ 14. 36 ). Heart rate, hepatic function and renal function were not obviously influenced during β-R therapy. Conclusion β-R significantly improved clinical treatment outcomes for infantile hemangiomas, and without serious adverse events. Among different kinds of drugs,timolol had an advantage of administration mode,meanwhile to some extent decreased the rate of complications,while this finding needed to be supported by further studies.