影响成人血友病患者活动能力的相关因素分析

An analysis of the factors affecting the activity of adults with hemophilia

目的:探索成人血友病患者的活动能力及其相关影响因素。方法:收集44例成人血友病患者的基本信息,关节功能状况采用血友病关节健康评估表的中文版(HJHS 2.1)进行评估,活动能力采用功能独立性评分表(FISH)和血友病活动列表(HAL)分别进行客观、主观方面的评估。结果:评估了44例患者的264个关节,患者关节功能异常的比率为85.6%,HAL的平均分为62.9±19.91,FISH的平均分为22.3±4.28。多元线性回归分析提示年龄、出血频率与活动能力总分呈负相关(P<0.01),FISH中的自我照顾能力评分与HJHS评分中的双肘评分及年龄呈负相关(P<0.05),转移能力评分与双膝评分及年龄呈负相关(P<0.05),步行能力评分与双膝评分呈负相关(P<0.001);Pearson相关分析提示FISH和HAL评分与HJHS中的肌肉萎缩情况、关节活动度、肌力、步态呈负相关(P<0.05,P<0.01),患者活动能力自评分数(HAL)和医师所评的分数(FISH)呈高度相关(r=0.785,P<0.001);体重指数和凝血因子水平与活动能力评分的相关性无显著性意义(P>0.05)。结论:关节功能状况、出血频率、年龄是活动能力的影响因素,提示成人血友病患者应采取综合治疗措施减少出血次数、保护关节以提高活动能力。

Objective: To explore the activities of adults with hemophilia and their influencing factors.Method: The basic information of 44 adults with hemophilia was collected and the status of joint function was assessed by the Chinese version(HJHS 2.1) of the hemophilia joint health score. The status of activity was evaluated by the functional independence score in hemophilia(FISH) objectively and by hemophilia activities list(HAL) subjectively.Result: Two hundred sixty-four joints of 44 patients were evaluated, in which the rate of abnormal joint function was 85.6%,the mean score of HAL was 62.9±19.91 and the average score of FISH was 22.3±4.28. Multiple linear regression analysis showed that there was negative correlation between the age,the bleeding frequency and the activity score(P<0.01). The elbow score of HJHS and age were negatively correlated with the selfcare score of FISH(P<0.05). There was negative correlation between the knee score of HJHS, the age and the transfer score of FISH(P<0.05). The knee score of HJHS was negatively correlated with the mobility score of FISH(P<0.001). Pearson correlation analysis showed that the scores of FISH and HAL were negatively correlated with the scores of muscle atrophy, the joint activity, the muscle strength and the gait in HJHS(P<0.05,P<0.01) and the subjective score HAL was highly correlated with the objective score FISH(r=0.785,P<0.001).There was no significant correlation between the body mass index, the coagulation factor and the activity score(P>0.05).Conclusion: The age, joint function, bleeding frequency are influencing factors of the activities of adults with hemophilia. Adults with hemophilia should take measures to reduce the number of bleeding and protect joints to improve the activities.