血友病并发低钙血症对凝血的影响及防治研究

The Investigation of Effect of Hypocalcemia Associated with Hemophillia on Coagulation and the Control

目的研究血友病并发低钙血症对凝血的影响及其防治方法。方法 2007年2月至2010年7月,陕西医大血液病研究院对随机接诊的360例血友病患者于治疗前及补钙治疗3周后复查血清钙浓度,观察其疗效。并对正常人及血友病患者进行不同浓度氯化钙活化部分凝血活酶时间(APTT)试验,观察钙对凝血的影响。结果血友病低钙血症的发病率为77.56%(279/360例),血清钙浓度为(1.78±0.29)mmol/L。治疗3周后与治疗前相比,血钙浓度增加(0.73±0.03)mmol/L,比较差异有统计学意义(P<0.01)。不同浓度氯化钙对血友病及正常人APTT试验:正常人依次为(35.33±5.85)、(58.33±10.50)、(95±18.02)、(188.66±21.73)s,血友病患者依次为(83.66±9.50)、(145.33±24.01)、(166.33±11.59)、(264.33±30.36)s,比较差异有统计学意义(P<0.01)。结论血友病患者低钙血症并发率为77.56%,APTT延长与血清钙浓度降低相关,为防治血友病出血提供了科学依据和新思路。

Objective To observe the effect of hypocalcemia associated with hemophilia on coagulation and to study the methods of prevention and treatment. Methods 360 hemphillia patients admitted by Hema- tology Institute of ShaanXi Medical University from Feb. 2007 to Jul. 2010 were randomly collected. The con- centrations of serum calcium were determined before and after treatment with calcium for 3 weeks to observe the therapeutic effect. Activated partial thromboplastin time（APTT） test with different calcium chloride con- centrations was conducted for hemophiilia patients and healthy volunteers to observe the effect of calcium on coagulation. Results The complication rate of hypocalcemia in hemophillia was 77.56% （ 279/360 ）. The concentration of pre-treatment average serum calcium was（ 1.78 ±0.29） mmol/L,and post-treatment（2.51 ± 0.32） mmol/L（ P 〈 0.01 ）. The results of APTT test in different concentrations of calcium chloride for healthy volunteers and hemophilia patients were as follows respectively：healthy volunteers：（ 35.33 ± 5.85 ） s, （58.33 ± 10.50 ） s, （95 ± 18.02 ） s, and （ 188.66 ± 21.73 ） s ; hemophillia patients ： （ 83.66 ± 9.50 ） s, （ 145.33 ±24.01 ） s, （ 166.33 ± 11.59 ） s, and （ 264.33 ± 30.36） s, the difference has statistical signifi- cance（ P 〈 0.01 ）. Conclusion The complication rate of hypocalcemia in hemophillia was 77.56%. The prolongation of APTT was related with the hypocalcemia, which may provide a scientific base and a new idea to the prevention and the treatment for hemophilia hemorrhage.