β受体阻滞剂治疗婴幼儿血管瘤有效率和安全性的系统评价和Meta分析

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1 097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<0.000 01)；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=0.000 2)。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。

The efficacy and safety of beta-receptor blocker for infantile hemangiomas treatment: a systematic review and meta-analysis

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.