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Wang W, Xu L, Wu J, Liu W, Jin J, Huang J, Xu Z, Huang Y, Li B, Liu Y, Zhang Q, Zhou M, Peng J, Hu Q. Clinical analysis and quality of life survey of hemophilia B patients in the central and western regions of China. Front Pediatr 2024; 12:1366990. [PMID: 38783919 PMCID: PMC11111977 DOI: 10.3389/fped.2024.1366990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/25/2024] [Indexed: 05/25/2024] Open
Abstract
Objective To study the current status of hemophilia B (HB) patients in the central and western regions of China. Methods This cross-sectional, multicenter study was conducted in seven provinces in the central and western regions of China from April 2019 to June 2023. Samples were collected for the factor IX activity, inhibitor screen, and gene mutation. Furthermore, the status of six index joints and quality of life (QoL) were assessed. Results A total of 185 HB patients (mild 15, moderate 75, and severe 95) with a median age of 12.17 years were enrolled. 30.3% (56/185) of patients had a family history of HB. 34.6% (64/185) of HB patients had diagnostic delay and 38.5% (69/179) experienced treatment delay. The incidence of inhibitors was 6.1% (11/179). We identified 123 genetic variants in this study, with missense mutations being the most common. 84.0% (89/106) of HB mothers were genetically identified as carriers, with 27.7% (13/47) of carriers having clotting factor levels less than 0.40 IU/ml. 71.4% (132/185) of HB patients had a history of joint hemorrhage, with a rate of target joint in these patients was 64.4% (85/132). Lower extremity joints were most often affected in patients. The Hemophilia Joint Health Score (HJHS) score was significantly positively correlated with the Hemophilia Early Arthropathy Detection with Ultrasound in China (HEAD-US-C) (r = 0.542, P < 0.001). Patients who received prevention treatment, inhibitor negative, without treatment delay, and without high-intensity replacement therapy showed a higher total score of the short form-36 health survey (SF-36). Conclusions One-third of HB patients had delay in diagnosis and treatment, and the incidence of inhibitors was 6.1%. Target joints were present in nearly half of HB patients. Missense was the main mutation type. 84.0% of mothers of HB patients in this study were found to be carriers. HEAD-US-C and HJHS can complement each other in the evaluation of joint status and give a valid basis for early clinical management. Early detection and preventive treatment, as well as reducing high-intensity replacement therapy and inhibitor generation, can effectively improve the QoL of patients.
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Affiliation(s)
- Wen Wang
- Department of Pediatrics, Huazhong University of Science and Technology Tongji Medical College Tongji Hospital, Wuhan, China
| | - Li Xu
- Department of Hematology, The Second People's Hospital of Anhui Province, Hefei, China
| | - Jingsheng Wu
- Department of Hematology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Weiyong Liu
- Department of Ultrasound, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Jiao Jin
- Department of Pediatrics, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jing Huang
- Department of Pediatrics, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Zhongjin Xu
- Department of Hematology, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Yali Huang
- Department of Hematology, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Bai Li
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yufeng Liu
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qing Zhang
- Haemophilia Diagnosis and Treatment Center, Department of Hematology and Oncology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Min Zhou
- Haemophilia Diagnosis and Treatment Center, Department of Hematology and Oncology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jie Peng
- Department of Hematology, Xiangya Hospital Central South University, Changsha, China
| | - Qun Hu
- Department of Pediatrics, Huazhong University of Science and Technology Tongji Medical College Tongji Hospital, Wuhan, China
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Huang Y, Wan C, Guan T, Xi X. Current status of treatment and disease burden of a cohort of hemophilia B in China. Front Public Health 2024; 11:1303787. [PMID: 38328542 PMCID: PMC10847226 DOI: 10.3389/fpubh.2023.1303787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/15/2023] [Indexed: 02/09/2024] Open
Abstract
Objective Hemophilia B is a rare X-chromosome linked hereditary bleeding disorder. Patients require lifelong treatment and it is costly, but there is a lack of research in China on the treatment and burden for this group. Our aim was to review the actual treatment pattern of hemophilia B patients in China, and describe the financial burden and other disease burden from the patient's perspective. Methods Using data collected by the Beijing Hemophilia Home Care Center, descriptive statistics were made on the sociodemographic characteristics and treatment of patients. The annual drug costs were calculated according to the actual factor dosage and price. Results During the study period, 29.9% of the patients only received on-demand treatment, while the rest of the patients received varying numbers of prophylaxis treatment. The total cost of clotting factors for 341 patients in one year was 16.0 million CNY ($2.5 million), with 46990.8 CNY ($7283.7) per patient. The drug cost of prophylaxis was significantly higher than that of on-demand treatment. The amount of prothrombin complex concentrates used by patients was the largest, more than 5 times of recombinant coagulation factor IX. Based on the average annual wage and average working time of Chinese employees in 2021, the average annual wage loss of HB patients reached 31544.2 CNY ($4889.4). The results of the questionnaire showed that 77.1% and 65.3% of patients had chronic pain and acute pain of different frequencies. Conclusion The level of prophylaxis for Chinese patients is low; safer and more effective recombinant drugs are not widely available. Patients also face a high burden of drug costs, as well as indirect costs that cannot be underestimated. Therefore, continued efforts are needed to improve the quality of life of patients by reducing their financial burden and promote standardized treatment.
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Affiliation(s)
- Yiwen Huang
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, China
| | - Chuchuan Wan
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, China
| | - Tao Guan
- Beijing Hemophilia Home Care Center, Beijing, China
| | - Xiaoyu Xi
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, China
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[Expert recommendations on homogenization management of the diagnosis and treatment of rare diseases in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:663-671. [PMID: 37529946 PMCID: PMC10414169 DOI: 10.7499/j.issn.1008-8830.2304036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/26/2023] [Indexed: 08/03/2023]
Abstract
Rare diseases in children are characterized by low prevalence, complex pathogenesis, variety, and difficulty in the diagnosis and treatment. With the development of medical services, progress has been made in the diagnosis and treatment of rare diseases. However, due to asymmetric allocation of medical resources at different levels, there are still many shortcomings in the establishment and promotion of the homogenized management system of rare disease diagnosis and treatment. In order to further standardize the homogenized management of rare diseases in children, achieve early and accurate diagnosis and treatment, and improve the quality of life of the children, the Rare Disease Diagnosis and Treatment Center of Tianjin Children's Hospital (Tianjin University Children's Hospital) invited relevant experts in the field to develop recommendations for the management model of homogenized diagnosis and treatment of rare diseases in children from the aspects of information construction, hierarchical diagnosis and treatment, personnel training, scientific popularization, and multi-participation. The recommendations provide reference for the regional homogenization of clinical diagnosis and treatment management system for children with rare diseases.
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Qu C, Liu W, Chen L, Zhang L, Xue F, Yang R. Analysis of hospitalization of people with hemophilia-12 years of experience in a single center. Res Pract Thromb Haemost 2022; 6:e12764. [PMID: 35873216 PMCID: PMC9301475 DOI: 10.1002/rth2.12764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 05/04/2022] [Accepted: 05/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background To what extent hospital use and medical resources are used on hemophilia care in China's health care system is unknown. Objectives This study was based on a single center in China and was conducted to comprehensively assess the resource use for hospitalization of people with hemophilia. Methods We analyzed clinical characteristics, diagnosis, inhibitor status, reasons, length of stay, and hospital costs of 323 hospitalizations in which hemophilia must be considered as the main factor for hospitalization from January 2009 to December 2020 at the Institute of Hematology and Blood Diseases Hospital in Tianjin, China. Results There were 265 hospitalizations for people with hemophilia A (HA) and 58 with hemophilia B (HB). Seventy‐eight hospitalizations (24%) were for patients with inhibitor (INH+). Minor bleeding (eg, hemarthrosis, hematuria) was the most common reason for hospitalization. The cost of clotting factor concentrates was the major burden of inpatients with hemophilia. Total cost in a single hospitalization of a person with HA (median, 21,281 Chinese yuan [¥]) was about twice that for HB (median, ¥11,060). Expenditure of drugs in HA (median ¥14,157) was two to three times more than that in HB (median, ¥5707). Total cost and drug cost in hospitalizations of people with inhibitors were about two times more than these without (INH–) (median cost in INH+ hospitalizations: total cost, ¥27,303; drug cost, ¥20,445. Median cost in INH– hospitalizations: total cost, ¥17,743; drug cost, ¥11,973.). Conclusions For hemophilia, the most dominant cost during hospitalization was on clotting factor concentrates. Diagnosed HA and inhibitor positivity increased the global cost.
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Affiliation(s)
- Cuiyun Qu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases Tianjin China
| | - Wei Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases Tianjin China
| | - Lingling Chen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases Tianjin China
| | - Lei Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases Tianjin China
| | - Feng Xue
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases Tianjin China
| | - Renchi Yang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases Tianjin China
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Wang Y, Yang Q, Zheng L, Wang X, Jiang W, Lu L, Yan L, Zhang M, Chen L. Efficacy of Individualized Preventive Treatment of Patients with Severe Hemophilia A Guided by Multiple Clinical Parameters and Pharmacokinetics. Acta Haematol 2021; 145:354-361. [PMID: 34879368 DOI: 10.1159/000521360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/15/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the effect of multiple clinical parameters (age, weight, blood types, and bleeding types) on FⅧ pharmacokinetic parameters (PK parameters) in adult patients with severe hemophilia A (SHA), draw up individualized preventive treatment plans, and observe clinical efficacy and economic benefit. METHODS Forty SHA patients treated in our hospital from January 2018 to May 2019 were enrolled, with their age, weight, blood types, bleeding types, and PK parameters measured to analyze the effects of clinical parameters on PK parameters. Individualized preventive treatment was developed, and patients were followed up for 1 year. The annual bleeding times (ABR), annual joint bleeding times (AJBR), and annual FⅧ dosage were observed and compared before and after treatment. RESULTS Weight, blood types and bleeding types could affect the PK parameters of FVIII. A prevention plan was formulated under the guidance of FVIII half-life. After 1 year of follow-up, ABR decreased by 88.9%, AJBR decreased by 90%, and annual FⅧ dosage increased by 47%. The dosage of FⅧ in 8 patients after was less than that before prevention, and the average half-life time of these 8 patients was 13.32 h. CONCLUSIONS 1. Weight, blood types, and bleeding types of adult SHA patients could affect FVIII half-life. As body mass index increased, FVIII half-life were significantly prolonged. The FVIII half-life of patients with type O blood were significantly shorter than those with other blood types, and the FVIII half-life of knee joint bleeding were conspicuously shorter than those of elbow joint bleeding. 2. Individualized preventive treatment could markedly reduce bleeding times. For patients with a long half-life period, the total annual FⅧ dosage could be reduced to achieve bleeding prevention and economic benefit.
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Affiliation(s)
- Youqun Wang
- Department of Hematology, Taizhou First People's Hospital, Huangyan Hospital of Wenzhou Medical University, Taizhou, China
| | - Qiao Yang
- Department of Hematology, Taizhou First People's Hospital, Huangyan Hospital of Wenzhou Medical University, Taizhou, China
| | - Liangda Zheng
- Department of Hematology, Taizhou First People's Hospital, Huangyan Hospital of Wenzhou Medical University, Taizhou, China
| | - Xianting Wang
- Department of Hematology, Taizhou First People's Hospital, Huangyan Hospital of Wenzhou Medical University, Taizhou, China
| | - Wenhua Jiang
- Department of Hematology, Taizhou First People's Hospital, Huangyan Hospital of Wenzhou Medical University, Taizhou, China
| | - Lijun Lu
- Department of Hematology, Taizhou First People's Hospital, Huangyan Hospital of Wenzhou Medical University, Taizhou, China
| | - Lixia Yan
- Department of Hematology, Taizhou First People's Hospital, Huangyan Hospital of Wenzhou Medical University, Taizhou, China
| | - Miaomiao Zhang
- Department of Hematology, Taizhou First People's Hospital, Huangyan Hospital of Wenzhou Medical University, Taizhou, China
| | - Lili Chen
- Department of Hematology, Taizhou First People's Hospital, Huangyan Hospital of Wenzhou Medical University, Taizhou, China
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[Consensus of Chinese expert on the diagnosis and treatment of rare bleeding disorders (version 2021)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 42:89-96. [PMID: 33858037 PMCID: PMC8071661 DOI: 10.3760/cma.j.issn.0253-2727.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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[Orthopedic treatment of musculoskeletal disorders in hemophilic patients]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 41:903-907. [PMID: 33333692 PMCID: PMC7767814 DOI: 10.3760/cma.j.issn.0253-2727.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To study the orthopedic treatment strategy for hemophilia complicated with musculoskeletal disorders as well as the peri-operative consumption of clotting factor. Methods: Total 338 orthopedic surgeries were performed for 261 patients, average age of 30.6 y (6-65 y) , with hemophilia between January 1996 and December 2019 at our institute. Two hundred and twenty-six patients presented with bleeds within the joints. Sixty-one patients presented with intramuscular bleeds, 45 presented with hemophilic pseudotumors, and six presented with miscellaneous complaints. Strategy of clotting factor replacement therapy was designed as per differences in the level of the operation procedure. Information regarding clinical manifestation, operative strategy, clotting factor consumption, and re-operation for complications was retrospectively recorded. The costs for multiple joint procedure and single joint procedure were studied. Results: We found that 270 of the 338 surgical procedures were major surgical procedures (79.9%) . There were 203 procedures of joint arthroplasty (60%) . Fourteen patients underwent reoperations for local recurrence (4.2%) . The average factor Ⅷ consumption before the surgery was 44.4 ± 8.1 IU/kg. The average FⅧ consumption within postoperative 2 weeks was 40 962 IU (647±177 IU/kg) . Seven type A hemophilic patients developed F Ⅷ inhibitor following the surgical procedure, with an average level of 13.7±11.2 BU/mL. Sixty-eight patients underwent multiple joint procedures under one anesthesia session (26%) . There was no significant difference in the factor consumption between the multiple joint procedure and single joint procedure. Conclusions: Surgical treatment was found to be effective for hemophilic arthropathy and lesion of the musculoskeletal apparatus, with the clotting factor replacement therapy. Multiple joint procedures under one anesthesia were more cost effective for patients with hemophilia, with less factor consumption than staged single joint procedure.
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Zhang DS, Zheng JW, Zhang CP, Cai ZG, Li LJ, Liao GQ, Shang ZJ, Sun MY, Han ZX, Shang W, Meng J, Gong ZC, Huang SY. [Multidisciplinary team model for patients with oral cancer and systemic diseases: an expert consensus]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2020; 38:603-615. [PMID: 33377335 PMCID: PMC7738912 DOI: 10.7518/hxkq.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/10/2020] [Indexed: 02/05/2023]
Abstract
Large general hospitals currently play an increasingly important role in the diagnosis and treatment for acute critical patients and difficult diseases because of the development of dual referral system and hierarchical diagnosis, as well as the formation of medical treatment alliance. Patients with oral cancers are often associated with systemic diseases, which increases the complexity of the condition. Thus, meeting the demand through the traditional single medical model is difficult. As such, a multidisciplinary team (MDT) model has been proposed and has achieved a good clinical effect. To standardize the application of this model, we organized an event in which relevant experts discussed and formulated a consensus to provide standardized suggestions on the MDT process and the diagnosis and treatment of common systemic diseases as reference for clinical practice.
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Affiliation(s)
- Dong-Sheng Zhang
- Dept. of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250012, China
| | - Jia-Wei Zheng
- Dept. of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Chen-Ping Zhang
- Dept. of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Zhi-Gang Cai
- Dept. of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Peking University, Beijing 100081, China
| | - Long-Jiang Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Gui-Qing Liao
- Dept. of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Sun Yat-sen University, Guangzhou 510120, China
| | - Zheng-Jun Shang
- Dept. of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan 430070, China
| | - Mo-Yi Sun
- Dept. of Oral and Maxillofacial Surgery, The Third Affiliated Hospital, Air Force Medical University, Xi'an 710032, China
| | - Zheng-Xue Han
- Dept. of Head and Neck Oncology Surgery, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China
| | - Wei Shang
- Dept. of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Jian Meng
- Dept. of Stomatology, Xuzhou Central Hospital, Xuzhou 221009, China
| | - Zhong-Cheng Gong
- Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Sheng-Yun Huang
- Dept. of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250012, China
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[Chinese guidelines on the treatment of hemophilia (version 2020)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 41:265-271. [PMID: 32295333 PMCID: PMC7364913 DOI: 10.3760/cma.j.issn.0253-2727.2020.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Wu R, Sun J, Xu W, Hu Q, Li W, Xiao J, Yang F, Zeng X, Zeng Y, Zhou J, Matytsina I, Zhang S, Pluta M, Yang R. Safety and Efficacy of Turoctocog Alfa in the Prevention and Treatment of Bleeding Episodes in Previously Treated Patients from China with Severe Hemophilia A: Results from the Guardian 7 Trial. Ther Clin Risk Manag 2020; 16:567-578. [PMID: 32606716 PMCID: PMC7320881 DOI: 10.2147/tcrm.s243146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 04/30/2020] [Indexed: 01/09/2023] Open
Abstract
Purpose Hemophilia care in China is characterized by widespread use of on-demand regimens and low-dose prophylaxis. With a limited number of approved recombinant factor VIII (FVIII) products, the incidence of arthropathy and disability in hemophilia patients remains high in China. The purpose of this trial was to evaluate the safety and efficacy of turoctocog alfa for prophylaxis and treatment of bleeding episodes in patients from China with severe hemophilia A across all age groups. Patients and Methods In this Phase 3, open-label trial, previously treated males of all ages with severe hemophilia A from China received turoctocog alfa for prophylaxis or on-demand treatment of bleeds. The primary endpoint was hemostatic effect for the treatment of bleeds during the main phase of the trial. Secondary endpoints included annualized bleeding rate during prophylaxis and the frequency of FVIII inhibitor development. Results Overall, 42 pediatric patients (age <12 years) and 26 adolescent/adult patients (≥12 years) were dosed with turoctocog alfa; 51 patients initiated treatment with prophylaxis, while 17 patients initiated on-demand treatment. During the main phase of the trial (6 months), hemostatic success was 95.1%. During the full trial (up to 24 months), hemostatic success was 95.4%; the overall median ABR was 1.18 bleeds/patient/year for prophylaxis patients; and 25 (51.0%) of 49 patients with target joints at baseline had all target joints resolved. No FVIII inhibitors (≥0.6 BU) were reported. Conclusion Turoctocog alfa was safe and effective for prophylaxis and treatment of bleeding episodes and for surgery in patients from China with severe hemophilia A across all ages.
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Affiliation(s)
- Runhui Wu
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Children's Health Center, Beijing, People's Republic of China
| | - Jing Sun
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Weiqun Xu
- Department of Hematology and Oncology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, People's Republic of China
| | - Qun Hu
- Department of Pediatric Hematology, Tongji Hospital, Tongji Medical College of HUST, Wuhan, People's Republic of China
| | - Wenqian Li
- Department of Hematology and Rheumatology, Qinghai Provincial People's Hospital, Xining, People's Republic of China
| | - Jianwen Xiao
- Department of Hematology, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Feng'e Yang
- Department of Hematology, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
| | - Xiaojing Zeng
- Department of Blood Transfusion, The Affiliated Hospital of Guizhou Medical University, Guiyang, People's Republic of China
| | - Yun Zeng
- Department of Hematology, First Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China
| | - Jianfeng Zhou
- Department of Pediatric Hematology, Tongji Hospital, Tongji Medical College of HUST, Wuhan, People's Republic of China
| | - Irina Matytsina
- Biopharm Medical & Science, Novo Nordisk A/S, Søborg, Denmark
| | - Sali Zhang
- Biopharm Clinical, Medical and Regulatory Affairs, Novo Nordisk (China) Pharmaceuticals Co., Ltd, Beijing, People's Republic of China
| | - Michael Pluta
- Statistical Consultancy, Quanticate Ltd, Hitchin, UK
| | - Renchi Yang
- Thrombosis and Haemostasis Centre, State Key Laboratory of Experimental Hematology, Tianjin Laboratory of Blood Disease Gene Therapy, CAMS Key Laboratory of Gene Therapy for Blood Diseases, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
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Shang BJ, Yang SW, Lei PC, Ma RJ, He XD, Yuan XL, Jiang L, Li YL, Dong XY, Wang Z, Zhang L, Zhu ZM. [Clinical study on factor Ⅷ inhibitor in children with hemophilia A]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 41:138-142. [PMID: 32135631 PMCID: PMC7357942 DOI: 10.3760/cma.j.issn.0253-2727.2020.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
目的 探讨血友病A(HA)患儿凝血因子Ⅷ(FⅧ)抑制物产生的相关因素及抑制物产生前后出血与关节病表现的差异。 方法 对2015年1月至2018年8月河南省血友病管理中心登记收治的381例16岁以下HA患儿进行回顾性分析。 结果 381例HA患儿中,轻型116例(30.4%),中间型196例(51.4%),重型69例(18.1%)。FⅧ抑制物阳性患者54例(14.2%),高滴度、低滴度分别为22、32例。血友病家族史与FⅧ抑制物阳性相关[P<0.001,OR=3.299(95%CI 1.743~5.983)];高强度暴露与FⅧ抑制物的产生相关[P=0.002,OR=2.587(95%CI 1.414~4.731)]。高强度暴露与高滴度FⅧ抑制物产生相关[P=0.001,OR=8.689(95%CI 2.464~30.638)]。54例HA患者产生抑制物后,总体关节年出血率、创伤性年出血率增加(z=−3.440,P=0.001;z=−2.232,P=0.026),而非关节年出血率、自发性年出血率与抑制物产生前比较差异无统计学意义(z=−1.342,P=0.180;z=−1.414,P=0.157)。关节超声评分较产生抑制物前差异无统计学意义(z=−0.632,P=0.527)。 结论 血友病家族史、高强度暴露可增加HA患儿发生FⅧ抑制物的风险,且高强度暴露可增加HA患者出现高滴度抑制物的风险。
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Affiliation(s)
- B J Shang
- Institute of Hematology of Henan Provincial People's Hospital, 450003, China; Henan Key laboratory of Stem Cell Differentiation and Modification, Zhengzhou 450003, China
| | - S W Yang
- Institute of Hematology of Henan Provincial People's Hospital, 450003, China; Henan Key laboratory of Stem Cell Differentiation and Modification, Zhengzhou 450003, China; Department of Hematology, Henan Provincial People' s Hospital/People's Hospital of Zhengzhou University, Zhengzhou 450003, China
| | - P C Lei
- Department of Hematology, Henan Provincial People' s Hospital/People's Hospital of Zhengzhou University, Zhengzhou 450003, China; Henan Provincial Registration Management Center of Hemophilia, Zhengzhou 450003, China
| | - R J Ma
- Department of Hematology, Henan Provincial People' s Hospital/People's Hospital of Zhengzhou University, Zhengzhou 450003, China
| | - X D He
- Department of Hematology, Henan Provincial People' s Hospital/People's Hospital of Zhengzhou University, Zhengzhou 450003, China; Henan Provincial Registration Management Center of Hemophilia, Zhengzhou 450003, China
| | - X L Yuan
- Department of Hematology, Henan Provincial People' s Hospital/People's Hospital of Zhengzhou University, Zhengzhou 450003, China
| | - L Jiang
- Department of Hematology, Henan Provincial People' s Hospital/People's Hospital of Zhengzhou University, Zhengzhou 450003, China
| | - Y L Li
- Institute of Hematology of Henan Provincial People's Hospital, 450003, China; Henan Key laboratory of Stem Cell Differentiation and Modification, Zhengzhou 450003, China
| | - X Y Dong
- Institute of Hematology of Henan Provincial People's Hospital, 450003, China; Henan Key laboratory of Stem Cell Differentiation and Modification, Zhengzhou 450003, China
| | - Z Wang
- Department of Hematology, Henan Provincial People' s Hospital/People's Hospital of Zhengzhou University, Zhengzhou 450003, China
| | - L Zhang
- Institute of Hematology of Henan Provincial People's Hospital, 450003, China; Henan Key laboratory of Stem Cell Differentiation and Modification, Zhengzhou 450003, China
| | - Z M Zhu
- Institute of Hematology of Henan Provincial People's Hospital, 450003, China; Henan Key laboratory of Stem Cell Differentiation and Modification, Zhengzhou 450003, China
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[Optimized AAV package and experimental application of recombinant AAV8/hFⅧ for gene therapy on hemophilia A mice]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 41:34-39. [PMID: 32023752 PMCID: PMC7357902 DOI: 10.3760/cma.j.issn.0253-2727.2020.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the effects of adeno-associated virus (AAV) carrying hFⅧ by serotype 8 (AAV8/hFⅧ) on hemophilia A (HA) mice by gene therapy strategy. Methods: pAAV-CB-EGFP, pH22 (serotype 2) and pfΔ6 (adenovirus helper) were used to package AAV into HEK-293 cells in different conditions (ratios of cells to plasmids). The efficiency of transfection and infection were evaluated using immunofluorescence microscope to seek an optimized package condition. pAAV-TTR-hFⅧ, pH 28 (serotype 8) and pfΔ6 were applied to package AAV8/hFⅧ in HEK-293 cells using the optimized package condition. The purified AAV8/hFⅧ were intravenously injected into HA mice and the effects of gene therapy were estimated. Results: The efficiency of package was evaluated according to the amount and intensity of enhanced green fluorescent protein (EGFP) under immunofluorescence microscope. Four package conditions including 10 cm-dish to transfect 10 μg plasmids, 20 cm-dish to 20 μg, 30 μg and 40 μg plasmids were employed, and the condition of 20 cm-dish to transfect 20 μg plasmids reached the highest transfection efficiency at 24 h, 48 h and 72 h after transfection. The small scale AAV-EGFP was packaged using the optimized condition and an AAV crude extract was harvested by a freeze-thaw method. HEK-293 and 16095 cells were infected by the AAV crude extract, and the preferential infection efficiency was recognized in 16095 cells under immunofluorescence microscope. Then, AAV8/hFⅧ was packaged and purified based on the optimized transfection condition, and the high purity of AAV8/hFⅧ was detected by Western blot. Fractions of AAV8/hFⅧ at the dose of 8×10(12) vg/kg were injected into HA mice through tail vein, an eye-bleeding was performed at every two weeks, and the activity of FⅧ was measured by aPTT assay. Results showed that the activity of FⅧ maintained at the therapeutic level and lasted up to 12 weeks after injection. Conclusion: The purified AAV8/hFⅧ based on the optimized package condition could play a role in HA mice gene therapy, and the long-term therapeutic effects of AAV8/hFⅧ were observed in vivo.
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Hua BL, Chelle P, Yeung C, Gu J, Zhao YQ, Iorio A. [Population pharmacokinetics of two recombinant human coagulation factor Ⅷ preparations in patients with hemophilia A]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:673-677. [PMID: 31495135 PMCID: PMC7342877 DOI: 10.3760/cma.j.issn.0253-2727.2019.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
目的 比较两种重组人凝血因子Ⅷ(FⅧ)制剂拜科奇(Kogenate® FS)与百因止(Advate®)在血友病A患者中的群体药代动力学差异,以期为血友病A患者精准个体化治疗提供理论依据。 方法 以WAPPS-Hemo项目中自2015年1月至2017年12月共纳入全球41个血友病中心至少接受过1次拜科奇或百因止注射的中间型/重型血友病A患者作为研究对象。计算两种FⅧ制剂的半衰期以及FⅧ活性到达2%的时间(TAT2%),并进一步分析不同年龄层和不同注射剂量下两种药物的药代动力学差异。 结果 ①拜科奇组117例,平均年龄为(27.6±17.7)岁;百因止组120例,平均年龄为(23.4±16.2)岁。两组患者均为男性。②拜科奇组、百因止组给药剂量分别为(31.5±13.1)IU/kg、(38.17±14.83)IU/kg,半衰期分别为(12.3±3.5)h、(10.8±2.9)h,TAT2%分别为(65.2±21.7)h、(57.0±17.9)h。③拜科奇组中≥12岁、<12岁患者的半衰期分别为(12.7±3.7)h、(11.1±2.5)h,TAT2%分别为(68.6±22.9)h、(55.8±14.6)h;百因止组中≥12岁、<12岁患者的半衰期分别为(11.4±3.1)h、(9.4±1.8)h,TAT2%分别为(61.1±18.0)h、(45.2±11.3)h。④拜科奇组中<20 IU/kg、20~29 IU/kg、30~39 IU/kg、≥40 IU/kg剂量组的半衰期分别为(13.3±4.0)h、(12.3±3.6)h、(12.2±3.5)h、(11.6±2.6)h,TAT2%分别为(61.5±21.4)h、(63.9±22.4)h、(67.0±24.3)h、(68.0±19.5)h;百因止组中<20 IU/kg、20~29 IU/kg、30~39 IU/kg、≥40 IU/kg剂量组的半衰期分别为(11.5±3.8)h、(11.4±3.7)h、(11.0±2.9)h、(10.4±2.3)h,TAT2%分别为(50.8±19.2)h、(56.7±21.0)h、(58.2±18.8)h、(58.1±15.8)h。 结论 在不同年龄组和不同注射剂量组,拜科奇的药代动力学参数均优于百因止。
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Affiliation(s)
- B L Hua
- Department of Hematology, School of Clinical Medicine, Yangzhou University, Yangzhou 225001, China; Department of Hematology, Peking Union Medical College Hospital, Beijing 100032, China
| | - P Chelle
- School of Pharmacy, University of Waterloo, Canada
| | - Cht Yeung
- Department of Health Research Methods, Evidence, and Impact Communications Research Laboratory, McMaster University, Canada
| | - J Gu
- Department of Hematology, School of Clinical Medicine, Yangzhou University, Yangzhou 225001, China
| | - Y Q Zhao
- Department of Hematology, Peking Union Medical College Hospital, Beijing 100032, China
| | - A Iorio
- Department of Health Research Methods, Evidence, and Impact Communications Research Laboratory, McMaster University, Canada
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Li J, Liu W, Guo XJ, Ding XL, Lyu BM, Xiao J, Sun QL, Li DS, Zhang WF, Zhong JC, Li CP, Yang RC. [HEAD-US-C quantitative ultrasound assessment scale in evaluation of joint damage in patients with moderate or severe hemophilia A received on-demand versus prophylaxis replacement therapy]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 39:817-821. [PMID: 30369202 PMCID: PMC7348284 DOI: 10.3760/cma.j.issn.0253-2727.2018.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
目的 探讨血友病关节超声评估量表(Haemophilic Early Arthropathy Detection with UltraSound in China,HEAD-US-C)对中间型/重型血友病A患者按需、预防治疗关节损伤评估的适用性。 方法 回顾性分析2015年6月至2017年7月70例接受肘、膝、踝关节超声检查的中间型及重型血友病A患者,应用HEAD-US-C超声评估量表及血友病关节健康评分量表2.1版(HJHS2.1)进行关节状况评分。对按需、预防治疗患者HEAD-US-C、HJHS评分进行相关性分析。 结果 70例中间型及重型血友病A患者共接受919例次关节超声检查。在中间型血友病患者中,按需、预防治疗组患者中位年靶关节出血次数差异无统计学意义[1(0,7)对1(0,5),z=1.271,P=0.137]。按需治疗组中位HEAD-US-C评分[1(0,6)对0.5(0,3),z=0.177,P=0.046]及HJHS评分[2(0,4)对2(0,3),z=0.375,P=0.007]明显高于预防治疗组。重型血友病患者按需、预防治疗组中位HEAD-US-C评分分别为4(0,7)、1(0,6)(z=2.189,P=0.008),中位HJHS评分分别为4(1,6)、2(0,5)(z=3.646,P<0.001),年靶关节出血次数分别为3(0,8)、2(0,8)(z=0.780,P=0.037),按需治疗组均高于预防治疗组。按需、预防治疗组患者HEAD-US-C评分与HJHS评分均存在正相关关系(P值均<0.05)。重型患者按需、预防治疗组HEAD-US-C评分与HJHS评分的相关系数分别为0.739(95%CI 0.708~0.767)、0.865(95%CI 0.848~0.880),95%CI不重合(P<0.05),预防治疗组两评分系统间具有更强的相关性。 结论 中间型/重型血友病A患者预防治疗疗效明显优于按需治疗。HEAD-US-C超声评估量表可有效评估中间型/重型血友病A患者按需、预防治疗关节损伤状况,与HJHS系统一致性较好,可为临床疗效评估提供客观指标。
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Affiliation(s)
- J Li
- Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | | | | | | | | | | | | | | | | | | | | | - R C Yang
- Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
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Xue F, Liu W, Cheng YF, Liu XF, Huang YT, Fu RF, Zhang L, Yang RC. [Immune tolerance induction in a case of hemophilia B with inhibitor with prothrombin complex concentrate and rituximab]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 38:749-753. [PMID: 29081190 PMCID: PMC7348358 DOI: 10.3760/cma.j.issn.0253-2727.2017.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
目的 探讨血友病B伴抑制物的免疫耐受诱导(ITI)治疗,提高血友病B伴抑制物的诊疗水平。 方法 应用基于APTT标准曲线的一期法测定重型血友病B患者凝血因子Ⅸ(FⅨ)活性,应用Bethesda法进行FⅨ抑制物定量测定;利用凝血酶原复合物(PCC)进行ITI并联合利妥昔单抗清除患者抑制物。 结果 患儿既往PCC暴露日为20 d,抑制物滴度峰值为56 BU/ml。在2015年11月患儿抑制物滴度降至10.4 BU/ml时开始ITI治疗,单用PCC一段时间无效,给予PCC联合利妥昔单抗治疗,17个月后成功清除患者体内FⅨ抑制物,未发生过敏反应及肾病综合征等并发症。ITI过程中患者年化出血率有所改善。 结论 该患者是国内首例报道的采用ITI联合利妥昔单抗成功治疗血友病B伴抑制物的病例。PCC联合利妥昔单抗ITI治疗是目前有希望清除血友病B抑制物的方法。
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Affiliation(s)
- F Xue
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Hospital of Blood Diseases, CAMS & PUMC, Tianjin 300020, China
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Li J, Guo XJ, Ding XL, Lyu BM, Xiao J, Sun QL, Li DS, Zhang WF, Zhou JC, Li CP, Yang RC. [Clinical application and optimization of HEAD-US quantitative ultrasound assessment scale for hemophilic arthropathy]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 39:132-136. [PMID: 29562448 PMCID: PMC7342577 DOI: 10.3760/cma.j.issn.0253-2727.2018.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
目的 评价HEAD-US评估量表在血友病性关节病临床应用的可行性,提出优化的超声评估量表HEAD-US-C。 方法 2015年7月至2017年8月期间,91例血友病患者接受1 035例次关节超声检查,分别采用Melchiorre、HEAD-US、HEAD-US-C量表进行评分,分析与血友病关节健康评分量表(HJHS)评分之间的相关性并比较上述量表评价血友病性关节病的敏感性。 结果 91例患者均为男性,中位年龄16(4~55)岁,血友病A 86例,血友病B 5例。1 035例次关节检查Melchiorre、HEAD-US、HEAD-US-C量表的评分[M(P25, P75)]分别为2(0,6)、1(0,5)、2(0,6),均与HJHS评分之间存在相关关系(相关系数分别为0.747、0.762、0.765,P值均<0.001)。Melchiorre、HEAD-US-C、HEAD-US评分量表的阳性率分别为63.0%(95%CI 59.7%~65.9%)、59.5%(95%CI 56.5%~62.4%)、56.6%(95%CI 53.6%~59.6%),差异有统计学意义(P<0.001)。336例次无症状关节(HJHS评分0分)Melchiorre、HEAD-US-C、HEAD-US评分量表的阳性率分别为25.0%(95%CI 20.6%~29.6%)、17.0%(95%CI12.6%~21.1%)、11.9%(95%CI 8.4%~15.7%)(P<0.001)。40例有关节出血症状的血友病患者(107例次)关节出血前、出血后超声评分差异有统计学意义(P<0.05)。HEAD-US-C与HEAD-US评分的变化幅度比较,差异有统计学意义(P<0.001)。 结论 与Melchiorre比较,HEAD-US、HEAD-US-C与HJHS之间具有相似的良好的相关性。HEAD-US-C评分量表较HEAD-US更为敏感,尤其适合亚临床状态血友病性关节病的评估。
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Affiliation(s)
- J Li
- Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | | | | | | | | | | | | | | | | | | | - R C Yang
- Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
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庄 金, 孙 雪, 周 璇, 柳 竹, 孙 竞. [Prophylactic treatment with low- and intermediate-dose factor VIII in children with severe hemophilia A: comprehensive evaluation of joint outcomes and correlation analysis]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:496-501. [PMID: 29735454 PMCID: PMC6765665 DOI: 10.3969/j.issn.1673-4254.2018.04.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To study the effect of low- and intermediate-dose factor VIII (FVIII) for prophylactic treatment of severe hemophilia A in children by comprehensively evaluating the outcomes of the joints. METHODS Forty-seven children with severe hemophilia A (FVIII activity ≤2%) were enrolled in this study. Eighteen of the children received prophylactic treatment with low-dose FVIII (10 U/kg, 2-3 times a week), 20 received prophylactic treatment with intermediate-dose FVIII (15-30 U/kg, 3 times a week), and 9 received on-demand treatment with FVIII infusion when bleeding occurred according to the Chinese Expert Consensus on the Diagnosis and Treatment of Hemophilia. The children were followed up for 180 days to observe the changes in the indexes of clinical bleeding phenotype, joint structure, joint function, and joint mobility, and the correlation of these indexes were analyzed. RESULTS Compared with on-demand treatment, prophylactic treatment with low- and intermediate-dose FVIII significantly improved the clinical hemorrhage phenotype (P<0.01), and the improvement was significantly more conspicuous with intermediate-dose prophylactic treatment (P<0.05). Comprehensive evaluation of the joint structure and function changes showed that compared with on-demand treatment, prophylactic treatment with low- and intermediate-dose FVIII resulted in significant improvements in the total score of Hemophilia Joint Health Score (HJHS), Functional Independence Score in Hemophilia (FISH), the single most severe target joint ultrasound and HJHS score of the target joint (P<0.05) and prophylactic treatment with intermediate-dose FVIII appeared to produce better outcomes of the joint than low-dose FVIII. No correlation was found between annual target joint bleeding rate (ATJBR) and ultrasound score, between ATJBR and HJHS change, or between annual joint bleeding rate (AJBR) and the total score of FISH (P>0.05). CONCLUSION Compared with on-demand treatment, prophylactic treatment with low- and intermediate-dose FVIII can significantly improve the bleeding phenotype and delay the progression of joint injury, but the clinical hemorrhagic phenotype is not sufficient to monitor the disease progression.
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Affiliation(s)
- 金木 庄
- />南方医科大学南方医院血液科,广东 广州 510515Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 雪岩 孙
- />南方医科大学南方医院血液科,广东 广州 510515Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 璇 周
- />南方医科大学南方医院血液科,广东 广州 510515Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 竹琴 柳
- />南方医科大学南方医院血液科,广东 广州 510515Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 竞 孙
- />南方医科大学南方医院血液科,广东 广州 510515Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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