CAJ | 학술논문

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。
목적：탐색중등강도운동대중형혈우병A환인혈FⅧ활성급정체응혈상황적영향，이기평고중형혈우병인동삼가체육운동적안전성，이급위중형혈우병A인동제정개성화운동방안제공보조수단。방법선취11례진단위중형혈우병A적환인삼가기차운동，체도중등운동강도적목표심솔후，유지차심솔계속기차10 min。운동전、후취혈양분별진행혈FⅧ활성급혈전탄력도적검측분석。자료적분석채용통계학연건SPSS 19．0。결과①11례환인적평균년령위12．7세（6～15세），운동적평균시간위11．8 min（10～13 min），재운동중급기후24 h무출혈사건급기타불괄증상。②11례환인운동전FⅧ활성위0．66（0．5～0．8）u/dl，운동후위0．93（0．5～2．3）u/dl。유4례재운동후혈FⅧ활성≥1．0 u/dl，점36．36％（4/11）。단11례환인운동전、후혈FⅧ활성비교무현저성차이（P＝0．052）。장혈FⅧ활성운동전후적차치여환인적년령주상관성분석，정정상관（P＜0．05）；장차치여환인적BMI주상관성분석，무현저성차이（P＞0．05）。③혈전탄력도각지표균유현저지변화，R축단（P＜0．05），K축단（P＜0．05），a각증가（P＜0．05），MA증가（P＜0．05），CI증가（P＜0．01）。기중，7/11（63．6％）운동후CI치증가체50％이상，3/11（27．3％）CI치증가위20％이하，1/11（9．1％） CI치증가위10％이하．결론①중형혈우병A환인삼가중등강도체육운동시상대안전적。②삼가중등강도운동，수연총체상혈FⅧ활성재운동전후무현저적차별，단유36．36％환인재운동후혈Ⅷ인자활성≥1．0 u/dl。③종혈전탄력도적분석간，운동후중형혈우병A환인적총체응혈공능경향우증강。응제창혈우병환인삼가괄도적운동。
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 .