中等強度运动增强重型血友病A患儿的整体凝血功能

Moderate-Intensity Exercise Enhances Global Hemostatic Function in Children with Severe Hemophilia A

目的探索中等強度运动对重型血友病A患儿血FⅧ活性及整体凝血状况的影响,以期评估重型血友病儿童参加体育运动的安全性,以及为重型血友病A儿童制定个性化运动方案提供辅助手段。方法选取11例诊断为重型血友病A的患儿参加骑车运动,达到中等运动强度的目标心率后,维持此心率继续骑车10 min。运动前、后取血样分别进行血FⅧ活性及血栓弹力图的检测分析。资料的分析采用统计学软件SPSS 19.0。结果①11例患儿的平均年龄为12.7岁（6～15岁）,运动的平均时间为11.8 min（10～13 min）,在运动中及其后24 h无出血事件及其他不适症状。②11例患儿运动前FⅧ活性为0.66（0.5～0.8）u/dl,运动后为0.93（0.5～2.3）u/dl。有4例在运动后血FⅧ活性≥1.0 u/dl,占36.36%（4/11）。但11例患儿运动前、后血FⅧ活性比较无显著性差异（P=0.052）。将血FⅧ活性运动前后的差值与患儿的年龄做相关性分析,呈正相关（P〈0.05）;将差值与患儿的BMI做相关性分析,无显著性差异（P＞0.05）。③血栓弹力图各指标均有显著地变化,R缩短（P〈0.05）,K缩短（P〈0.05）,a角增加（P〈0.05）,MA增加（P〈0.05）,CI增加（P〈0.01）。其中,7/11（63.6%）运动后CI值增加达50%以上,3/11（27.3%）CI值增加为20%以下,1/11（9.1%）CI值增加为10%以下.结论①重型血友病A患儿参加中等强度体育运动是相对安全的。②参加中等强度运动,虽然总体上血FⅧ活性在运动前后无显著的差别,但有36.36%患儿在运动后血Ⅷ因子活性≥1.0 u/dl。③从血栓弹力图的分析看,运动后重型血友病A患儿的总体凝血功能倾向于增强。应提倡血友病患儿参加适度的运动。

Objective This study evaluated the effect of moderate-intensity exercise on FⅧ activity and global hemostatic status of the children with severe hemophilia A and safety for children with severe hemophilia A to participate in physical activities. Methods Eleven children with severe hemophilia A participated in a moderate intensity exercise test by continuing pedaling stationary bicycle for 10 minutes after reaching the target heart rate. Plasma FⅧ activity and thromboelastography（ TEG） were assessed before and after the physical activity. Data were analyzed by the software of SPSS 19. 0. Results（ 1） The average age of the 11 children was 12. 7 years（ 6 ～ 15 years）. The average duration of exercise was 11. 8 minutes（ 10 ～ 13 minutes）.There were no bleeding events or any other uncomfortable symptoms during the exercise and 24 hours after.（ 2） The average FⅧ activity of the 11 children was 0.66（ 0.5 ～0.8） u/dl before and 0.93（ 0.5 ～2.3） u/dl after exercise. While 4 of the 11 children（ 36. 4%） had the FⅧ activity increased to≥1. 0 u /dl after exercise,Overall,the increase in FⅧ in the 11 children as a group was not statistically significant（ P = 0. 052）.We did find a positive correlation between the increase of FⅧ activity and age（ P〈0. 05）,but no correlation between the increase of FⅧ activity and BMI（ P 〉 0. 05）.（ 3） There were significant changes of TEG indexes;with shortening of,R（ P〈0. 05）,and increase in K decrease（ P〈0. 05）,alpha angle（ P 〈 0. 05）,MA i（ P〈 0. 05）,and CI（ P 〈 0. 01）. Among the 11 children,the relative CI increase after exercise was 〉 50 in 7（ 63.6%）,〈20% in 3（ 27.3%）,and 10% in one（ 9. 1%）. Conclusion（ 1） It was relatively safe for children with severe hemophilia A to do moderate intensity exercises.（ 2） In 36. 4% of these children,the FⅧ activity increased to ≥1. 0 u /dl after moderate-intensity exercise,although overall,there was no significant difference in FⅧ activity before and after exercises.（ 3） TEG analysis showed the whole hemostatic function for the children with severe hemophilia A tended to be enhanced after exercise. We conclude that children with hemophilia A should be encouraged to take part in proper sport activities.