Analysis Of Risk Factors Of Factor Ⅷ Antibody Formation In Hemophilia A Patients

Objective:Through a retrospective analysis of Jiangxi Province People’s Hospital onset of59 cases of hemophilia A(HA)features of hospitalized patients with clinical data exploration risk factor of HA inhibitor,inhibitor is positive for the future clinical prevention and treatment in patients with hemophilia provides guidance and help.Methods:Collected in Jiangxi Province People’s Hospital in June 2010 to March 2019 hospitalized HA patients,a total of 59 patients,including FⅧ inhibitor positive patients,29 cases and 30 patients with negatie inhibitor(2011 year),records of patients with basic factor Ⅷ(FⅧ)level,HA family history,inhibitor of HA family history,age at first diagnosis,inhibitor cause bleeding,intensive treatment,treatment for the first time,inhibitor drops,trauma surgery history,history of fever,vaccination history,history of bleeding,gene detection,target organ damage,and clotting function,liver and kidney function,such as clinical data,and were retrospectively analyzed.Result:1.The cases of our hospital HA inhibitor positive in general characteristics: HA medium for 5 cases(17.3 %,heavy for 24 cases(82.7 %)9 cases(75 %)have a family history of hemophilia.2 cases(16.7 %)have a family history of inhibitor;Age at first diagnosis: < 1,6 cases(20.7%)and 1-10 of 10 cases(34.5%),> 10 of 13 cases(44.8%).Bleeding incentive for the first time: injection treatment of hemorrhage in 2cases(6.9 %),trauma,hemorrhage in 20 cases(69%),spontaneous bleeding7 cases(24.1 %).Improved treatment of 25 cases(86.2 %),Treatment: on-demand treatment of 26 patients(89.7%)and regular prevention in 3(10.3%).Highest inhibitor drop degrees: high degree of 15 cases(51.7%)low drop degree of 14 cases(48.3%),Surgery: 4 cases(13.8%)History of fever: 16 cases(55.1 %);History of vaccination: 0 cases;History of bleeding: 15 cases(51.7 %);Genetic testing: 0patients;Target organ damage: 29 patients(100%).2.Among 30 HA factor Ⅷ antibody negative inpatients,6(20%)had a history of operation,9(30%)had massive hemorrhage,12(40%)had a history of infection and fever,9(32%)had a family history of hemophilia,and 2 of them had an unknown family history of hemophilia.In the positive group,the blood group(n = 27): A: 11(40.7%),B: 6(22.2%),AB: 3(11.1%),O: 7(25.9%);in the negative group,the blood group(n = 27): A: 14(46.3%),B: 7(24.1%),AB: 4(13.0%),O: 16.7%.There was no significant difference in the family history of hemophilia between the positive group and the negative group(P < 0.05),but the history of bleeding in the positive group was higher than that in the negative group(P = 0.089).3.Inhibitor positive fibrinogen(FIB): 2.61(1.16-7.18),the inhibitor negative groups FIB: 2.52(1.30-5.97).There was no statistically significant difference between the two groups(P > 0.05).4.The median APTT of medium-sized HA patients with factor Ⅷ antibody positive group was 120,higher than that of factor Ⅷ antibody negative group(88)(P = 0.002),while there was no significant difference between heavy-duty HA patients with factor Ⅷ antibody positive group and negative group(108.6 vs 115.4,P = 0.756).Further subgroup analysis showed that the APTT median value of high titer group was higher than that of low titer group(130.8 vs 113.8,P = 0.026),while the difference between heavy high titer group and low titer group was not significant(107.3 vs 112.3,P = 0.629).5.The mean value of creatinine in the positive group was 54 μ mol / L,which was higher than that in the negative group(37.5 μ mol / L)(P < 0.05).Further subgroup analysis showed that the creatinine in the positive group was significantly higher than that in the negative group(59 μ mol / L vs 36 μ mol / L,P < 0.05),but there was no significant difference between the positive group and the negative group(48 μ mol / L vs 46 μ mol / L,P > 0.05).6.Antibody positive factor Ⅷ and factor Ⅷ antibody negative group of fibrinogen(FIB)of patients with HA and liver function indicators,including totalbilirubin,direct bilirubin,indirect bilirubin,ALT,AST,there were no statistically significant difference between the two groups(P > 0.05).Conclusion:1.This study suggests that hemophilia family history can promote the formation of factor Ⅷ antibody,while operation history,history of infection and fever during FVII infusion,blood type,FIB content,bilirubin and transaminase level have no effect on the formation of factor Ⅷ antibody,but massive hemorrhage has a trend of promoting the formation of factor Ⅷ antibody.2.Most of the patients with HA had no significant increase in the frequency of bleeding before and after the production of factor Ⅷ antibody.The higher the antibody titer,the higher the bleeding risk.