血友病性关节病预防治疗效果的超声评估  

Ultrasonic Evaluation of the Preventive Effect of Hemophilic Arthropathy

作　　者：王艺桦 李宁 刘洁 孟健 李鑫淼 张树华 WANG Yi-hua;LI Ning;LIU Jie;MENG Jian;LI Xin-miao;ZHANG Shu-hua(Department ofUltrasound,North China University of Science and Technology Affiliated Hospital,Tangshan,Hebei,063000,China)

机构地区：[1]华北理工大学附属医院超声科,河北唐山063000

出　　处：《现代生物医学进展》2024年第18期3452-3455,3479,共5页Progress in Modern Biomedicine

基　　金：河北省卫生健康委2023年度医学科学研究课题(20231249)。

摘　　要：目的:利用常规超声、能量多普勒(PDI)、超微血流成像(SMI)技术观察血友病A患者的关节病变情况,评价不同治疗方案的血友病患者预防治疗效果。方法:收集于华北理工大学附属医院就诊的重型血友病A患者,根据治疗方案的不同分为药代动力学(Pharmacokinetics,PK)指导个体化预防治疗组(A组)、标准剂量预防治疗组(B组)、低剂量预防治疗组(C组)、按需替代治疗组(D组)。分析比较各组间中国血友病早期关节病变超声评分(Haemophilic Early Arthropathy Detection with UltraSound in China,HEAD-US-C)评分及年化关节出血率(Annual joint bleeding rates,AJBR)变化情况。结果:随着治疗时间延长,A组、B组及C组HEAD-US-C评分有所下降,A组下降程度较B组和C组明显,D组有所上升;四组患者AJBR有所增加,D组差值变化较其他三组明显,A组差值变化幅度最低。HEAD-US-C评分与AJBR具有相关性。结论:预防治疗可减缓血友病患者的关节病变加重,有效缓解关节炎症及减少出血次数,PK指导个体化预防治疗效果优于其他预防治疗及按需替代治疗,关节HEAD-US-C评分可以对关节进行评估,对于评价血友病治疗效果具有一定的应用价值,为临床诊疗提供影像学依据。Objective:To observe the joint lesions in patients with hemophilia A using conventional ultrasound,power Doppler imaging(PDI),and super-micro flow imaging(SMI)techniques,and evaluate the preventive treatment efficacy of different treatment regimens in hemophilia patients.Methods:Severe hemophilia A patients who were admitted to North China University of Science and Technology Affiliated Hospital were collected and divided into four groups according to different treatment regimens:Pharmacokinetics(PK)guided individualized preventive treatment group(group A),standard dose preventive treatment group(group B),low dose preventive treatment group(group C),and on-demand replacement treatment group(group D).Haemophilic Early Arthropathy Detection with UltraSound in China(HEAD-US-C)and annual joint bleeding rates(AJBR)were analyzed and compared among the groups.Results:As the treatment time increased,the HEAD-US-C scores in group A,B,and C decreased,with a more significant decrease in group A than group B and C,while there was an increase in group D.The AJBR in all four groups increased,with a more significant change in group D than the other three groups,and the change in group A was the lowest.There was a correlation between HEAD-US-C score and AJBR.Conclusion:Preventive treatment can slow down the progression of joint lesions in hemophilia patients,effectively alleviate joint inflammation and reduce bleeding times.PK guided individualized preventive treatment is superior to other preventive treatments and on-demand replacement treatment.The HEAD-US-C can be used to assess joints,which has certain application value for evaluating the therapeutic effect of hemophilia,providing imaging evidence for clinical diagnosis and treatment.

关 键 词：血友病性关节病 超声HEAD-US-C评分 超微血流成像技术 药代动力学 预防治疗 

分 类 号：R554.1[医药卫生—血液循环系统疾病]