【摘要】 目的 探討重組人凝血因子Ⅷ制劑小劑量短程預(yù)防性輸注能否有效減少中重度血友病A患兒關(guān)節(jié)出血問(wèn)題。 方法 對(duì)2008年11月-2009年4月期間就診的13例年齡3~11歲的中重度血友病A患兒，均在為期2個(gè)月內(nèi)接受重組人凝血因子Ⅷ 2次/周、間隔3 d、每次7.5~10.0 U/kg的靜脈預(yù)防性輸注，記錄治療前2個(gè)月與治療2個(gè)月時(shí)關(guān)節(jié)出血次數(shù)，以及同一關(guān)節(jié)反復(fù)發(fā)生出血的情況?！〗Y(jié)果 治療前關(guān)節(jié)出血的發(fā)生次數(shù)為（3.77±2.13）次，治療后關(guān)節(jié)出血的發(fā)生次數(shù)為（0.46±0.87）次，治療前后比較，差異有統(tǒng)計(jì)學(xué)意義（Plt;0.01）；治療前靶關(guān)節(jié)出血的發(fā)生率為35.7％，治療后靶關(guān)節(jié)出血的發(fā)生率為0.0%，治療前后比較，差異有統(tǒng)計(jì)學(xué)意義（Plt;0.01）?；純褐委煶杀炯s510~680元/（kg?2個(gè)月）?！〗Y(jié)論 重組人凝血因子Ⅷ制劑小劑量短療程預(yù)防性輸注能有效減少中重度血友病A患兒關(guān)節(jié)出血次數(shù)，同時(shí)可有效減少靶關(guān)節(jié)出血的發(fā)生率，從而在一定程度上保護(hù)關(guān)節(jié)的功能。治療費(fèi)用相對(duì)可接受?！続bstract】 Objective To evaluate the efficacy of low-dose short-course infusion of recombinant human factor Ⅷ concentration in treating joint bleeding in children with severe and moderate hemophilia A. Methods Thirteen children aged 3 to 11 years old with severe or moderate hemophilia A were included in the present study from November 2008 to April 2009. For children in the treatment group, they were treated with low-dose short-course infusion of recombinant human factor Ⅷ concentration with a dose of 7.5-10.0 U/kg twice weekly as secondary prophylaxis for two months. The incidence of joint bleeding 2 months before treatment (control group) and during the 2 months of treatment (treatment group) was observed. Moreover, the incidence of their target joint bleeding was measured in both groups. Results Children in the control group had (3.77±2.13) joint bleedings while children in the treatment group had (0.46±0.87) joint bleedings, which was obviously lower than those in the control group (Plt;0.01). Meanwhile, the incidence of target joint bleeding in the treatment group was 0%, which was obviously lower than that in the control group (35.7%) (Plt;0.01). In the treatment group, the costs of treatment were about RMB 510-680 yuan/kg every 2 months. Conclusions Treatment with low-dose short-course infusion of recombinant human factor Ⅷ concentration can effectively decrease joint bleeding in children with severe and moderate hemophilia A, and can effectively decrease the incidence of target joint bleeding. Therefore, this method may play an important role in protection of the joint function in those patients at an acceptable cost.
獲得性血友病A是一種發(fā)病率極低但病死率較高的自身免疫性疾病。多種原因?qū)е禄颊唧w內(nèi)產(chǎn)生了特異結(jié)合、滅活凝血因子Ⅷ的凝血因子抑制物而發(fā)病?；颊咴谄潴w內(nèi)凝血因子抑制物完全清除之前都處于嚴(yán)重出血甚至致死的風(fēng)險(xiǎn)之中。因此，如何正確合理地選擇免疫抑制劑來(lái)進(jìn)行抑制物清除治療是消除患者出血風(fēng)險(xiǎn)，達(dá)到長(zhǎng)期穩(wěn)定完全緩解以及最終治愈該病的重要環(huán)節(jié)。
目的系統(tǒng)評(píng)價(jià)凝血因子Ⅷ治療血友病A的藥物經(jīng)濟(jì)學(xué)研究。方法計(jì)算機(jī)檢索PubMed、EMbase、Web of Science、The Cochrane Library、CNKI、VIP和WanFang Data數(shù)據(jù)庫(kù)，搜集凝血因子Ⅷ治療血友病A的藥物經(jīng)濟(jì)學(xué)研究，檢索時(shí)限均為建庫(kù)至2022年2月。由2名研究者獨(dú)立篩選文獻(xiàn)、提取資料并評(píng)價(jià)納入研究的偏倚風(fēng)險(xiǎn)后，從研究模型、研究參數(shù)和不確定性分析等方面進(jìn)行定性系統(tǒng)評(píng)價(jià)。結(jié)果最終納入17個(gè)藥物經(jīng)濟(jì)學(xué)研究。納入研究總體質(zhì)量較高，絕大多數(shù)符合藥物經(jīng)濟(jì)學(xué)研究的基本框架，但仍存在模型設(shè)定、參數(shù)選擇等方面的不足。大部分研究結(jié)果顯示凝血因子Ⅷ對(duì)血友病A的預(yù)防治療與按需治療相比具有成本-效果優(yōu)勢(shì)。結(jié)論當(dāng)前證據(jù)顯示，凝血因子Ⅷ對(duì)血友病A的預(yù)防治療相較于按需治療可能具有一定的成本-效果優(yōu)勢(shì)，但仍需在中國(guó)環(huán)境下驗(yàn)證。