摘要
目的:观察低分子肝素钠(LM-WH)治疗难治性肾病综合征(RNS)临床疗效,抗凝效果及安全性。方法:将35例伴高凝状态的原发性肾病综合征患者随机分为两组,对照组予强的松1mg/(kg·日)+环磷酰胺50mg,2次/日口服+甲基强的松龙0.5～1g[20mg/(kg·次)]加入5%葡萄糖液250ml静脉点滴,治疗组在对照组治疗方案基础上加LMWH 5000IU皮下注射2次/日,共观察4周,治疗前后均观察临床症状体征及24小时尿蛋白定量和肾功能的变化,并检测抗凝血酶原Ⅲ(AT-Ⅲ)、血纤维蛋白原(FIB)、D-二聚体、活性Xa因子(FXa)、活性IIa因子(FIIa)。结果:治疗4周后两组24小时尿总蛋白、尿素氮(BUN)、血肌酐(Cr)明显下降(P<0.05),血清白蛋白(ALB)、内生肌酐清除率(Ccr)明显升高(P<0.05),但治疗组中24小时尿总蛋白下降显著大于对照组(P<0.05),血清白蛋白上升显著高于对照组(P<0.05),治疗组治愈率和显效率明显高于对照组(P<0.05),无效率明显低于对照组(P<0.05)。治疗组中AT-III明显升高(P<0.05),FIB、D-二聚体、FXa活性明显降低(P<0.05),FIIa无明显变化,无1例并发深静脉血栓形成,对照组中上述指标无明显变化,且5例出现深静脉血栓形成。结论:在激素、环磷酰胺治疗难治性肾病综合征基础上加用LMWH可尽快缓解RNS的高凝状态,减少尿蛋白,升高血清白蛋白,提高治愈率,减少血栓并发症,且有良好的安全性。
Objective：To observe the clinical efficacy and anticoagulant effects and safety of LMWH on treatment of RNS.Methods：35 patients of primary NS complicated with hypercoagulabale state were randomly divided into two groups：the control and the treated groups.The control group was treated with prednisolone（1mg/kg·d） plus oral cyclophosphamide（50mg bid） plus methylprednisolone 0.5～1g（20mg/kg·time） in glucose 250ml（5%） intravenously by drip.While the treated group was administered,on the basis of the therapeutic scheme of the control group,with LMWH 5000IU hypodermic injection twice per day,for 4 weeks,the clinical symptoms and signs was observed in both groups before and after the treatment,the 24h urine protein quantitative determination、ALB、urine creatinine、Cr、BUN、AT-III、FIB、D-D、FXa、FIIa、and the endogenous creatinine clearance rate（Ccr） were also tested,the side effects in two groups were observed at the same time.Results：The 24h urine protein quantitative determination、BUN and Cr were significantly decreased（P0.05） in both groups,whereas the ALB and Ccr were obviously elevated（P0.05） 4 weeks after the treatment in the two groups.But the decreasement in the 24h urine protein quantitative determination in the treated group was lower than that in the control group（P0.05）,and the increasement in the ALB in the treated group was higher than that in the control group（P0.05）,and the curing rate in the treated group was higher than that in the control group（P0.05）,and the inefficacy rate in the treated group was lower than that in the control group（P0.05）.A significant increasement in AT-III（P0.05） and decreasement in FIB、D-D、FXa（P0.05） and no significant changes in FIIa were observed in the treated group,not any intravenous thrombus formation was found in the patients.In the control group,no significant changes in these markers was found,and deep venous thrombosis was found in 5 patients.Conclusion：On the basis of the hormone plus cyclophosphamide on treatment of RNS,the LMWH can be relieved,the hypercoagulabale state of the RNS more quickly,decrease the urine protein,increase the ALB,improve the curing rate,decrease the thrombus-complication,and the treatment is safe.
