咪喹莫特治疗婴幼儿血管瘤

摘要

Objective To explore the clinical application of imiquimod for the treatment of infantile hemangiomas( IH ).Methods 320 children with IH,including 250 superficial cases,20 deep cases,and 50 mixed cases,were treated with 5％ imiquimod cream every other day for 16 weeks.The clinical efficacy and side effects were evaluated at one year of age.Results The total effective rates of the superficial,deep,and mixed IH were 61.2％ (153/250),10.0％ (2/20) and 60.0％ (30/50)respectively,showing no statistical difference between superficial and deep type ( P =0.874 ),but significant difference between superficial and mixed (P ＜ 0.01 ),deep and mixed type (P ＜ 0.01 ).56.0％(28/50) of mixed IH showed proliferation of its deep lesions.Slight skin erythema and crusting were the most common side effects.Conclusions 5％ imiquimod cream is effective and safe in superficial IH and superficial lesions of mixed IH with minimal skin reactions.The dysplasia of local tissue and systemic growth retardation are not found.It should be avoided to apply the cream to IH located around the cavities and skin fold.Imiquimod cream is a simple and convenient home-nursing medication.It can reduce care burden of family.Thus topical use of imiquimod can be considered as a good clinical indication for the treatment of superficial lesions of IH.%目的 探讨咪喹莫特治疗婴幼儿血管瘤( infantile hemangioma,IH)的临床适应证.方法 320例婴幼儿血管瘤,浅表型250例,深在型20例,混合型50例,年龄3～24周,隔日夜间睡前外用5％咪喹莫特乳青涂擦16周,随访至1岁.疗效评价分为6级,1级:完全消退；2级:75％≤消退≤99％；3级:50％≤消退＜75％；4级:25％≤消退＜50％；5级:消退＜25％；6级:未消退或增生.记录局部皮肤反应及全身不良反应.结果 浅表型、深在型、混合型IH的有效率分别为61.2％(153/250)、10.0％ (2/20)、60.0％( 30/50).浅表型和混合型之间比较差异无统计学意义(P=0.874),浅表型与深在型之间比较差异有统计学意义(P＜0.01),深在型与混合型之间比较差异有统计学意义(P＜0.01).咪喹莫特外用后4～8周,IH开始生长控制并出现消退现象.56.0％ (28/50)混合型IH出现深部病灶的增生.皮肤反应主要为红斑、表皮剥落、结痂,程度轻微.结论 浅表型IH和混合型IH的浅表病灶是外用咪喹莫特治疗的适应证,治疗后局部皮肤反应轻微,不引起局部组织萎缩和身体发育迟滞,对腔穴部位及皮肤皱褶处应避免使用,用药方式简单便捷,可作为IH浅表病灶的安全有效的治疗方法.