中等強度运动增强重型血友病A患儿的整体凝血功能

摘要

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 hemo -philia 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 FⅧactivity and thromboelastography ( TEG) were assessed before and after the physi-cal activity.Data were analyzed by the software of SPSS 19.0.Results (1) The average age of the 11 chil-dren 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 FⅧactivity 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 exer-cise,Overall,the increase in FⅧin the 11 children as a group was not statistically significant (P=0.052). We did find a positive correlation between the increase of FⅧactivity and age(P<0.05),but no correlation between the increase of FⅧactivity 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 FⅧactivity 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 .%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。