| Objectives Ultrasound scoring of hemophilia bone and joint lesions was used to evaluate the bone and joint lesions(including joint effusion,synovial thickness,synovial blood flow and articular cartilage)in patients with hemophilia A under different course and different treatment options.Change the situation to provide a reliable imaging basis for clinically more effective treatment options for patients with hemophilia A.Methods A total of 37 patients with hemophilia A who were admitted to the Department of Hematology of the Affiliated Hospital of North China University of Technology from October 2017 to December 2018 were selected.According to the different treatment options of patients with hemophilia A,they were divided into three groups,namely,on-demand replacement treatment group(Ⅰ group),13 patients(78 joints in total);prevention and replacement low-dose group(Ⅱ groups),12 cases.Patients(72 joints in total),preventive intermediate dose group(Ⅲ groups),12 patients(72 joints in total).Coronary color Doppler ultrasound was performed on three groups of patients with hemophilia A before treatment(T1),2 months after treatment(T2),4 months(T3),and 6 months(T4).Joint cavity effusion,synovial thickness,synovial blood flow,and osteochondral changes in each joint.Analyze and compare the differences in the ultrasound scores of bone and joint lesions in patients with hemophilia A at different observation points under different treatment regimens.Normal distribution data in statistical data are expressed as mean ± standard deviation.The differences of the ultrasound scores of the three groups of hemophilia A patients at different observation points were analyzed.Two-factor and multi-level repeated measures analysis of variance was used.The multiple comparisons were used to analyze the joint ultrasound scores of patients in the same group.The difference was analyzed and the differences in the ultrasound scores of the patients in different groups at the same time point were analyzed.The difference of the test level P<0.05(bilateral test)was statistically significant.Results 1 Ultrasound scores of joint effusion in 37 patients with hemophilia A(222 joints): 137 patients with hemophilia A were compared with ultrasound scores of joint cavity effusion at 4 different observation points,regardless of grouping The ultrasound score of the joint cavity effusion changed significantly with time(P<0.001).2 The scores of the joint effusion ultrasound scores of the three groups of hemophilia A patients varied with the trend of the observation points in different groups(P <0.001);3 three groups of hemophilia A patients with intra-articular effusion ultrasound scores were different between the groups(P < 0.001);4 in the on-demand replacement treatment group(group Ⅰ),preventive replacement low-dose group(Ⅱ Ⅰn the group)and the prevention and replacement middle-dose group(group Ⅲ),the ultrasound score of the joint cavity effusion decreased with the treatment time,and the effusion decreased(P<0.05).At 5T1,the three groups of hemophilia A patients had joints.There was no difference in the mean value of the mean score of the effusion in the effusion(P>0.05).At T2,T3 and T4,there were differences in the ultrasound scores of the joint effusion in the three groups of hemophilia A patients(P<0.001),and in the group Ⅲ.The joint cavity effusion had the lowest ultrasound score.2 Ultrasound scores of joint synovial thickness in 37 patients with hemophilia A(222 joints): 137 patients with hemophilia A(222 joints)at 4 different observation points(T1,T2,T3,T4)Ultrasound scores of synovial thickness were not considered,and the score of synovial thickness was significantly changed with time(P<0.001).2The scores of synovial thickness in three groups of hemophilia A patients were in different groups.The changes in the trend of observation time were different(P<0.05).The scores of synovial thickness in the three groups of hemophilia A patients were different(P<0.05);4 in the on-demand replacement treatment group(Ⅰ Group),preventive replacement low-dose group(group Ⅱ)and preventive middle-dose group(group Ⅲ)synovial thickness ultrasonic score with the prolongation of treatment time,the score decreased,the synovial thickness decreased(P<0.05);5T2 At the time of T3 and T4,the synovial thickness of the three groups of hemophilia A patients had different ultrasound scores(P<0.05).The synovial thickness of the group Ⅲ was significantly lower than that of the group Ⅰ and Ⅱ.3 Comparison of synovial blood flow ultrasound scores in 37 patients with hemophilia A(222 joints): 137 patients with hemophilia A(222 joints)slipped at 4 different observation points(T1,T2,T3,T4)The comparison of membranous blood flow ultrasound scores,regardless of grouping,synovial blood flow ultrasound scores significantly changed with time(P < 0.001);2 three groups of hemophilia A patients with synovial blood flow ultrasound scores in different groups The change of the trend at the time of observation was different(P <0.001);the scores of synovial blood flow in the three groups of hemophilia A patients were different between the groups(P<0.001);4 on-demand replacement therapy group(Ⅰ Group),preventive replacement low-dose group(group Ⅱ)and preventive middle-dose group(group Ⅲ)synovial blood flow ultrasound scores with prolonged treatment time,score decreased,synovial hyperplasia decreased(P<0.001);5T1 At the time,there was no difference in the mean values of synovial blood flow ultrasound scores among the three groups of hemophilia A patients(P>0.05).At T2,T3 and T4,the mean scores of synovial blood flow ultrasound scores in the three groups of hemophilia A patients were absolute.There were differences in values(P<0.001),in which group Ⅲ proliferative synovial blood flow ultrasound score was lower than Ⅰ And Group Ⅱ.4 Ultrasound scores of 137 hemophilia A patients(222 joints)at 4 different observation time points(T1,T2,T3,T4),regardless of grouping,articular cartilage changes with ultrasound score over time There was no significant change in recursion(P>0.05).2 The scores of osteochondral changes in the three groups of hemophilia A patients did not change significantly with the time point(P>0.05).The osteochondral changes in patients with A disease were significantly different between the groups(P<0.05);4 on-demand replacement treatment group(group Ⅰ),preventive replacement low-dose group(group Ⅱ)and preventive middle-dose group(group Ⅲ)joints The changes in osteochondral changes were not obvious,and the osteochondral injury did not improve(P>0.05).At 5T1,T2,T3 and T4,three groups of hemophilia A patients were at T1,T2,T3 or T4.The scores of osteochondral changes were different(P<0.05),and the scores of osteochondral changes in group Ⅲ were less than those in groups Ⅰ and Ⅱ.Conclusions 1 The prevention and replacement of the middle-dose group in the treatment of hemophilia A patients with joint cavity fluid,synovial thickness,synovial blood flow treatment are better than the preventive low-dose group and the on-demand replacement treatment group,and with the three groups of programs The longer the treatment time,the more significant the effect,so the long-term preventive treatment is the first choice to prevent the replacement of the medium dose.2 The treatment regimen of the three groups was not significant for the treatment of osteochondral changes.The effect of the three treatment regimens did not change significantly with the prolongation of treatment time.Therefore,when the patients with hemophilia A had no osteochondral changes during the disease.At the time,preventive treatment should be actively carried out to prevent osteochondral changes.Figure 5;Table 8;Reference 96... |
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