常规超声在检测血友病关节亚临床出血病变中的应用价值

Evaluation of conventional ultrasound in the detection of subclinical hemorrhage of hemophilia joint

目的探讨常规超声在检测血友病关节亚临床出血所导致的关节病变中的应用价值。方法收集2017年3月至2018年4月在南方医科大学南方医院血友病中心接受凝血因子Ⅷ预防治疗的27例重型血友病A患儿,分别在入组时和治疗1年后进行双肘、双膝、双踝关节超声检查和血友病关节健康评分2.1(Hemophilia Joint Health Score 2.1,HJHS 2.1),同时收集治疗期间各关节出血次数。结果27例患儿共157个关节坚持完成了1年治疗。74个关节在治疗期间未发生出血,其中超声总评分增加的关节为14个(14/74,18.9%),HJHS 2.1评分增加的关节为11个(11/74,14.9%)。108个关节HJHS 2.1评分无明显变化,其中超声总评分增加的关节有25个(25/108,23.1%)。93个关节超声总评分无明显变化,其中HJHS 2.1评分增加的关节有9个(9/93,9.7%)。结论超声在关节未发生出血及HJHS 2.1检查关节病变无明显进展时可以敏感地检测到血友病关节病变,为临床医生提供更准确的关节状态信息。

Objective To explore the application value of conventional ultrasound(US)in detecting occult bleeding lesions in joints of patients with hemophilia.Methods Twenty-seven children with severe hemophilia A who received factorⅧprophylactic treatment from March 2017 to April 2018 in Nanfang Hospital,Southern Medical University were enrolled.Clinical data were collected from routine practice accompanied with US examination,hemophilia joint health score(HJHS)2.1 assessment and the history of hemarthrosis of both ankles,elbows and knees at baseline and at 1 year follow-up.Results A total of 157 joints of 27 patients were followed up for one year.During the treatments,74 joints were found without history of hemarthrosis,among which the total US score of 14(14/74,18.9%)joints increased,and HJHS 2.1 score of 11(11/74,14.9%)joints developed.There was no significant change in the HJHS 2.1 score of 108 joints,among which 25 joints(25/108,23.1%)had an increase in the total US score.However,there was no significant change in the total US score for 93 joints,of which 9(9/93,9.7%)had an increase in HJHS 2.1 score.Conclusions US examination can sensitively detect hemophilia arthropathy in joints without history of hemarthrosis and without obvious progression of arthropathy by HJHS 2.1 examination,and provide clinicians with more accurate joint information.