Цель работы-поиск новых диагностических подходов для оценки фазы и распространенности постгеморрагического воспалительного процесса в суставах у больных с гемофилической артропатией. Используя метод компьютерной инфракрасной термографии, измеряли температуру над областью коленных, голеностопных суставов и голеней. Анализ полученных данных проведен с помощью специально разработанного алгоритма, положенного в основу компьютерной программы для ЭВМ (2009). Установлено, что при повышении температуры над суставами высок риск рецидивов гемартрозов. Если в суставе по данным анамнеза гемартрозов не было, то повышение температуры может свидетельствовать о латентно протекающем воспалении. Оценка распространенности воспалительного процесса в суставах у больных гемофилией имеет прогностическое значение. Для распространенного воспаления характерно непрерывно рецидивирующее течение, для ограниченного-ежемесячные рецидивы гемартрозов, при отсутствии воспаления в суставе, о чем свидетельствует нормальная или пониженная температура, вероятны редкие рецидивы гемартрозов. Ключевые слова: гемофилическая артропатия, диагностика, компьютерная инфракрасная термография.

Aim. To describe the blood biochemistry parameters in patients with hemophilia considering the level of lacking coagulation factor and AВ0 blood group to clarify the risk factors for complications of hemophilia and concomitant diseases. Methods. 300 patients with hemophilia A admitted due to bleedings were examined. The serum levels of albumin, urea, bilirubin, cholesterin, iron, aspartate aminotransferase were examined using an automatic biochemical analyzer. The control group included 185 healthy males of similar age. Results. Severe degree of hemophilia was diagnosed in 42% of patients, medium severity - in 36%, mild - in 22%. Low metabolic activity was found in patients with hemophilia. Blood cholesterol level of 3 mmol/l and less was the risk factor of anemia development in patients with hemophilia of any severity. In hemophilic patients with 0(I) blood group, serum iron level decrease was registered regardless of hemophilia severity, in patients with other blood groups decrease was noted in patients with medium and severe hemophilia. Serum iron level of 12 μmol/l and less was the risk factor for anemia. The albumin level was the highest in patients with AB (IV) blood group, with only a few cases of anemia diagnosed in these patients. Conclusion. In patients with hemophilia there is a tendency of losing cholesterol and serum iron while bleeding, which is the risk factor for anemia and other concomitant conditions development. Treating patients with hemophilia, it is important to consider the specific personal metabolic features associated with the AВ0 blood group and the level of lacking coagulation.

Introduction. Better understanding of the pathogenesis of hemophilic arthropathy is crucial for prevention of irreversible injury to joints in patients with hemophilia. Research objective - to define a role of altered regulation of microcirculation in formation of joint injury in patients with hemophilia. Methods. The changes in knee and ankle joints in 82 patients with hemophilia were investigated by means of ultrasound and X-ray. Microcirculation was evaluated using computer infrared thermography and laser doppler flowmetry in joints of 44 patients and 46 healthy individuals. Results. Increased temperature and perfusion (M) are major risk factors of hemarthrosis development (RR=1.86 and RR=1.26) and are characteristic of joints with hemorrhages developing more often than 1 time per month. Increase in these indexes in joints without hemarthrosis in the anamnesis is a sign of a latent inflammation. Both decrease in the index of shunting (IS) and increase in a vibration amplitude of perfusion in the endothelial range (Amax E) are characteristic of joints with a recurrence of hemarthrosis more often than 3 times a month. Decrease in indexes of M and Amax E with concomitant increase in PSh demonstrate low risk of hemarthrosis. Conclusions. Changes of microcirculation in joints represent an important factor in the pathogenesis of hemophilic arthropathy development in the patients with variable risk of a recurrence of a hemarthrosis. Joint inflammation leads to endothelial dysfunction with poor vasospasm, to increase in Amax E and M that is a new diagnostic sign of a latent inflammation in joints. Decrease of PSh promotes recurrence of hemarthrosis because of strengthening of an imbuing of tissues of joint blood. Preservation of endothelium-mediated vasoconstriction, decrease in the neurogenic tone, increase in shunting of blood are characteristic features of hemophilic arthropathy in patients with infrequent recurrence of hemarthrosis.