超声在中重度血友病A关节亚临床出血中的应用价值  

Study on the application of ultrasound evaluation in the subclinical hemorrhage of moderate to severe hemophilia A joint

作　　者：肖燕燕 蒋雪梅[2] 房云海[3] 王杰[3] 苏语涵 张峰[2] 崔延军[2] 孙晓娜 XIAO Yanyan;JIANG Xuemei;FANG Yunhai;WANG Jie;SU Yuhan;ZHANG Feng;CUI Yanjun;SUN Xiaona(The First Clinical Medical College of Shandong University of Traditional Chinese Medicine, Jinan 250014, P.R.China;Department of Special Inspection, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250014, P.R.China;Blood Center of Shandong Province, Jinan 250014, P.R.China)

机构地区：[1]山东中医药大学第一临床医学院,山东济南250014 [2]山东中医药大学附属医院特检科,山东济南250014 [3]山东省血液中心,山东济南250014

出　　处：《医学影像学杂志》2020年第11期2087-2090,共4页Journal of Medical Imaging

基　　金：山东省医药卫生科技发展计划项目(编号:2018WS237);山东省医药卫生科技发展计划项目(编号:2018WS235)。

摘　　要：目的探讨应用超声检查对采用FⅧ按需治疗的中重度血友病A患者关节亚临床出血情况进行评估的临床价值。方法选取本院行关节超声检查的37例中重度血友病A患者资料,年龄2~37岁,平均年龄(12.1±9.2)岁,按平均年龄分为两组,第一组(2~12岁)23例,第二组(13~37岁)14例。两组患者共222个指标关节(双膝、双踝、双肘),无临床出血记录的指标关节(158个)和有临床出血记录指标关节(64个),均行超声检查,观察有无关节结构异常改变,并对两组患者指标关节临床出血记录与超声检查结果进行对比分析。结果无临床出血记录指标关节158个,经超声检查发现28.5%(45/158)的关节结构异常。有临床出血记录指标关节64个,经超声检查发现85.9%(55/64)的关节结构异常,14.1%(9/64)的关节结构无异常。关节出血的超声检出率(100/222,45.0%)显著高于临床出血记录(64/222,28.8%)(P<0.05)。12岁以上患者指标关节发生亚临床出血概率(26/45,57.8%)明显高于12岁及12岁以下患者(19/45,42.2%)(P<0.05)。结论超声检查能够准确反映关节早期病变,并客观提示采用FⅧ按需治疗的中重度血友病A患者关节亚临床出血,指导临床制定个性化治疗方案,对提高患者预后具有重要意义。Objective To explore the clinical value of using ultrasound in evaluating subclinical joint bleeds of patients with moderate-to-severe hemophilia A who are treated with FⅧon demand.Methods 222 index joints(ankles,elbows and knees)of 37 patients with moderate-to-severe hemophilia A enrolled in our hospital from January 2018 to December 2019 were examined by ultrasound at an average age of(12.1±9.2)years(range2~37 years),divided into two groups according to average age,the first group is 2~12 years old,the second group is 13~37 years old.Index joints with no clinical bleeding records(158),index joints with clinical bleeding(64),all index joints were examined by ultrasound to detection the joint structure changes.And comparative analysis of the number of two groups bleeding joints indicated by clinical records and ultrasound examination.Results There were 158 joints with no clinical bleeding records,28.5%(45/158)of which were found structural abnormalities by ultrasound examination.64 joints with clinical bleeding records,85.9%(55/64)of which joints were found structural abnormalities,and 14.1%(9/64)joints had no structural changes by ultrasound examination.The ultrasonic detection rate of joint damage(100/222,45.0%)is significantly higher than that of clinical(64/222,28.8%)(P<0.05).The index of subclinical bleeding in patients over 12 years old(26/45,57.8%)is significantly higher than that in patients under 12 years old and below(19/45,42.2%)(P<0.05).Conclusion Ultrasound plays an important role in detecting early joint damage and objectively suggest joint subclinical bleeding in patients with moderate to severe hemophilia A with FⅧon-demand therapy which help guide clinical treatment and improve prognosis.

关 键 词：超声检查 血友病 关节病 亚临床出血 

分 类 号：R554[医药卫生—血液循环系统疾病] R445.1[医药卫生—内科学]