Translational Research, Puget Sound Blood Center, and Professor of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Thromb Res. 2011 Jan;127 Suppl 1:S10-3. doi: 10.1016/j.thromres.2010.10.004. Epub 2010 Nov 5.
Older patients with hemophilia face many challenges related not only to hemophilia but also to general comorbidity associated with aging. Patients with hemophilia often have known risk factors for cardiovascular disease, such as hypertension and hepatitis C virus (HCV) infection, which may counteract any protective effects bestowed by the hypocoagulable state. Arthritis and joint disease are common and contribute to disability and pain. The high prevalence of chronic HCV infection has led to an increased risk for liver failure and hepatocellular carcinoma. Renal function and urological disorders are a concern in these patients, and issues related to sexuality are an important but often-overlooked issue. The use of routine procedures for general health maintenance in the elderly (e.g. colonoscopy) can be more complex in patients with hemophilia due to the inherent risk of bleeding, and serious disorders such as malignancy can be overlooked if signs of abnormal bleeding are attributed to hemophilia, rather than to cancer. Prospective studies are needed to address these challenges so that evidence-based guidance can be given to clinicians who treat older patients with hemophilia.
老年血友病患者面临许多挑战，这些挑战不仅与血友病有关，还与与衰老相关的一般合并症有关。血友病患者通常存在心血管疾病的已知危险因素，如高血压和丙型肝炎病毒（HCV）感染，这可能会抵消低凝状态带来的任何保护作用。关节炎和关节疾病很常见，会导致残疾和疼痛。慢性 HCV 感染的高患病率导致肝衰竭和肝细胞癌的风险增加。肾功能和泌尿系统疾病是这些患者关注的问题，与性行为相关的问题是一个重要但经常被忽视的问题。由于出血的固有风险，老年人常规健康维护（例如结肠镜检查）在血友病患者中可能更为复杂，如果异常出血的迹象归因于血友病而不是癌症，则可能会忽略严重疾病，如恶性肿瘤。需要进行前瞻性研究来应对这些挑战，以便为治疗老年血友病患者的临床医生提供循证指导。
