摘要
目的系统评价卡波西样血管内皮瘤(Kaposiform hemangioendothelioma,KHE)及丛状血管瘤(tufted angioma,TA)常用药物治疗的效果及安全性。方法检索PubMed、Embase、Web of Science、中国期刊全文数据库(CNKI)及万方数据库,查找并纳入关于KHE及TA药物治疗的临床观察性研究,采用R-3.6.2软件进行meta分析,分别对伴或不伴卡梅现象(Kasabach-Merritt phenomenon,KMP)的KHE及TA进行有效率及不良事件发生率的结果合并,并用SPSS 22.0对各组合并有效率及合并不良事件发生率进行比较。结果共纳入30篇文献,涉及治疗药物包括糖皮质激素、长春新碱、西罗莫司、普萘洛尔、长春新碱及糖皮质激素联合治疗。当KHE/TA伴发KMP时,长春新碱联合糖皮质激素的合并有效率(94.34%)与西罗莫司的合并有效率(96.43%)均高于其他疗法,差异有统计学意义,西罗莫司合并不良事件发生率(5.53%)相对较高,但差异无统计学意义;当不伴KMP时,西罗莫司合并有效率(94.23%)高于糖皮质激素(31.25%)、长春新碱(46.15%)及普萘洛尔(22.86%),差异有统计学意义,西罗莫司不良事件发生率为23.81%。结论对于伴发KMP的KHE/TA,长春新碱联合糖皮质激素治疗与西罗莫司治疗的效果最佳,西罗莫司不良事件发生率相对较高;对于不伴KMP的KHE/TA患儿,西罗莫司治疗效果最佳,但存在严重不良事件发生风险,糖皮质激素及长春新碱治疗效果相当,次于西罗莫司。
Objective To assess the efficacy and safety of common medication treatments on Kaposiform hemangioendothelioma(KHE)and tufted angioma(TA).Methods PubMed,Embase,Web of Science,CNKI and Wanfang database were searched to find out the observational studies on medication treatment of KHE and TA.R-3.6.2 was used for calculate the pooled response rate and pooled adverse events rate.Meta analyses were performed according to KHE and TA with and without Kasabach-Merritt phenomenon(KMP)respectively.SPSS 22.0 was used to compare the pooled rates among each therapy.Results A total of 30 studies regarding the medication treatment of KHE and TA were identified in this meta-analysis.Analyzed medicines included glucocorticoid,vincristine,sirolimus,propranolol,combination therapy of vincristine and glucocorticoid.The pooled results indicated that when referring therapy on KHE and TA with KMP,the pooled response rate of combination therapy(98.34%)and sirolimus(96.43%)was higher than that of other therapies,and the difference was statistically significant.The pooled adverse events rate of sirolimus(5.53%)was relatively higher than other modalities,with no statistically significance.As for therapy on KHE and TA without KMP,sirolimus(94.23%)had higher pooled response rate than glucocorticoid(31.25%),vincristine(46.15%)and propranolol(22.86%),with statistically significant differences.The pooled adverse events rate of sirolimus was 23.81%.Conclusions Our findings indicate that for KHE and TA with KMP,combination therapy(sirolimus+glucocorticoid)and vincristine have the best efficacy,while the adverse events rate of sirolimus is relatively high.For KHE and TA without KMP,sirolimus has the highest response rate,but there is also a risk of serious adverse events.Glucocorticoid and vincristine have comparable response rate,which both inferior to sirolimus.
作者
王璐颖
李少华
冶小云
吕仁荣
徐广琪
毕见海
霍然
Wang Luying;Li Shaohua;Ye Xiaoyun;Lyu Renrong;Xu Guangqi;Bi Jianhai;Huo Ran(Department of Plastic Surgery,Shandong Provincial Hospital Affiliated to Shandong University,Jinan 250021,China;Department of Plastic Surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China)
出处
《中华整形外科杂志》
CAS
CSCD
北大核心
2020年第4期375-384,共10页
Chinese Journal of Plastic Surgery
