反复输注血液制品对血友病抗体及凝血因子活性的影响

Effect of repeated transfusion of blood products on hemophilia antibodies and clotting factor activity

目的探讨反复输注血液制品对血友病抗体及凝血因子活性的影响及临床意义。方法选取2010年1月至2014年1月血友病A患者170例，随机分为观察组与对照组，观察组90例，反复输注血液制品（FⅧ制品）；另选取同期初始输注血液制品患者80例为对照组，以一期法检测FⅧ活性（FⅧ：C），并以改良的Bethesda法检测FN抗体（FⅧ：Ab）。结果观察组90例中，HA抗体阳性12例，阳性率为13．33％（12／90），抗体高、中、低分型依次为2例、8例和80例；对照组80例中，HA抗体阳性2例，阳性率为2．50％，观察组阳性率显著高于对照组（x^2=6．577，P〈0．05）。观察组FⅧ：A及APTT均显著高于对照组，差异有统计学意义（P〈0．05），观察组FⅧ：C水平各指标显著低于对照组，差异有统计学意义（P〈0．05）。结论对血友病A、B型患者采取反复输注方式会干扰凝血因子抗体，使凝血因子活性降低，对血友病的临床治疗带来不良影响。

Objective To study the effect of repeated transfusion of blood products on hemophil- ia antibodies and clotting factor activity. Methods From January 2010 to January 2014, 170 patients with hemophilia A were chosen as research objects, and they were randomly divided into observation group and control group. The 90 patients in the observation group had repeated transfusion of blood prod- ucts（ FⅧ products）, and another 80 patients with initial infusion of blood products at the same time were as the control group. The F VII/activity （F Ⅷ： C） was detected by first phase method, and improved Bethesda method was used to detect looking antibodies （F Ⅷ： Ab）. Results Among the 90 patients in the observation group, 12 cases had positive HA antibody, the positive rate was 13.33% （12/90）. Anti- body type high, medium and low grade in the order of 2 cases, 8 cases and 80 cases. Among the 80 cases in control group, 2 cases had positive HA antibody, the positive rate was 2. 50% （2/80）. The positive rate was significantly higher of observation group than that of control group （ X2 = 6. 577, P 〈 0. 05 ）. Group F Ⅷ ： A and APTF were significantly higher of observation group than those of control group, the differences were significant（P 〈 0. 05 ）, the team F Ⅷ： C level of each index was significantly lower of observation group than those of the control group, the differences were significant （P 〈 0. 05）. Conclusions Repeat- edly infusion ways may interfere with blood coagulation factor antibody of patients with hemophilia A and B type, lower the activity of clotting factors, has adverse effect on the clinical treatment of hemophilia.