晚期关节病变合并HIV感染的青年血友病患者

蔡华聪; 冯宾; 曹玮; 刘淑芬; 袁涛; 张燕; 李魁星; 赵永强; 王书杰

doi:10.12376/j.issn.2097-0501.2022.04.008

晚期关节病变合并HIV感染的青年血友病患者

doi: 10.12376/j.issn.2097-0501.2022.04.008

蔡华聪¹,
冯宾²,
曹玮³,
刘淑芬⁴,
袁涛⁵,
张燕⁶,
李魁星¹,
赵永强¹,
王书杰^1, ,

1.
中国医学科学院北京协和医院血液内科，北京 100730
2.
中国医学科学院北京协和医院骨科，北京 100730
3.
中国医学科学院北京协和医院感染内科，北京 100730
4.
中国医学科学院北京协和医院康复医学科，北京 100730
5.
中国医学科学院北京协和医院内分泌科，北京 100730
6.
中国医学科学院北京协和医院放射科，北京 100730

详细信息

通信作者:
王书杰, E-mail：wsj0630@sina.com

中图分类号: R512.91;R554+.1
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- 被引次数: 0
出版历程
- 收稿日期: 2022-08-17
- 录用日期: 2022-09-14
- 网络出版日期: 2022-12-23

A Young Hemophilia Patient with Advanced Hemophilic Arthritis and HIV Infection

1.
Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
2.
Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
3.
Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
4.
Department of Physical Medicine and Rehabilitation, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
5.
Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
6.
Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

More Information

Corresponding author: WANG Shujie, E-mail: wsj0630@sina.com

摘要

摘要: 一例青年男性, 自幼诊断重型A型血友病，反复关节出血、泌尿道出血等，预防治疗后年出血次数有所减少，因右膝关节出血加重、严重活动障碍就诊。因合并HIV感染等多种感染，经多学科协作团队(MDT)专家共同讨论, 考虑存在右膝关节置换手术指征，多学科支持下采用新型锆铌合金假体及术中导航技术完成膝关节置换，围手术期给予物理康复治疗，获得满意关节功能。同时血友病、HIV感染及抗病毒药物造成患者的骨质疏松，给予严密监测及治疗。多学科保驾年轻患者的晚期血友病性关节炎的手术治疗，并严密监测治疗骨质疏松。对该例患者的诊治体现了多学科协作在疑难罕见病诊疗过程中的重要意义。
- 血友病 /
- 关节炎 /
- HIV /
- 骨质疏松
Abstract: A young male diagnosed with severe hemophilia A since childhood, was presented with recurrent joint and urinary bleeding. Annualized bleed rates dropped below five with low dose prophylactic medication.Bleeding in the right knee joint recently aggravated. Due to coexisting HIV infection and advanced hemophilic arthritis, the patient was managed by a multi-disciplinary team(MDT).Total knee arthroplasty was performed by an experienced surgeon using modern prosthesis design and intraoperative navigation technologies.Physical and rehabilitation therapy was provided during the postoperative period, and joint function improved. The MDT managed the young patient with HIV infection and advanced hemophilic arthritis. The patient was diagnosed with osteoporosis thought to have been caused by hemophilia, HIV infection and antiviral drugs; and he received treatment. The treatment of this patient reflects the importance of multidisciplinary cooperation in the management of difficult and rare diseases.
- hemophilia /
- arthritis /
- HIV /
- osteoporosis
注释:

作者贡献：蔡华聪，王书杰：论文选题与文章撰写；蔡华聪，冯宾，曹玮，刘淑芬，袁涛，张燕，李魁星，王书杰：临床诊治; 冯宾，曹玮，刘淑芬，袁涛，张燕，李魁星，赵永强，：文章审阅与修改。

利益冲突：所有作者均声明不存在利益冲突。

HTML全文

图 1 膝关节X线片

A.双膝关节正位片；B.右膝关节侧位片；C.髌骨轴位片；D.双下肢站立位片

Figure 1. X-ray of knee joint

下载: 全尺寸图片幻灯片

表 1 围手术期及术后凝血因子用药方案

Table 1. Perioperative and postoperative coagulation factor medication regimen

围手术期	FⅧ用量
术日(术前1 h)	50 IU/kg
手术日(返室后)及术后D1~2	40 IU/kg q12h
术后D3~6	30 IU/kg q12h
术后D7~14	20~30 IU/kg qd
康复期	20~25 IU/kg tid(康复日)

下载: 导出CSV

参考文献(5)

[1]	中华医学会血液学分会血栓与止血学组, 中国血友病协作组. 血友病诊断与治疗中国专家共识(2017年版)[J]. 中华血液学杂志, 2017, 38: 364-370. doi: 10.3760/cma.j.issn.0253-2727.2017.05.002
[2]	Song X, Zhong J, Xue F, et al. An overview of patients with haemophilia A in China: epidemiology, disease severity and treatment strategies[J]. Haemophilia, 2021, 27: e51-e59.
[3]	张强. 中国人类免疫缺陷病毒感染者围手术期抗病毒治疗专家共识(第二版)[J]. 中华实验和临床感染病杂志(电子版), 2021, 15: 289-294.
[4]	Sossa Melo CL, Wandurraga EA, Peña AM, et al. Low bone mineral density and associated factors in patients with haemophilia in Colombia[J]. Haemophilia, 2018, 24: e222-e229. doi: 10.1111/hae.13516
[5]	Ekinci O, Demircioglu S, Dogan S, et al. Decreased bone mineral density and associated factors in severe haemophilia A patients: a case-control study[J]. Haemophilia, 2019, 25: e315-e321.