低分子量肝素在儿童难治性肾病中的应用

The application of low molecular weight heparin in refractory nephrotic syndrome of children

目的 探讨儿童难治性肾病合并高凝状态患儿的有效治疗措施 ,总结使用低分子量肝素 (LMWH)治疗 36例难治性肾病的经验。方法 在基本治疗的同时加用LMWH 1 0 0～ 1 2 0AXaIU·kg-1·d-1,2周为一疗程。每周监测出凝血时间、凝血酶原时间。 36例中 32例经肾组织活检 ,病理类型分别为 :微小病变 (MCNS) 5例、系膜增生 (MsPGN) 1 7例、膜增殖 (MPGN) 6例、局灶硬化 (FS GS) 4例。结果 经LMWH治疗 2周后 ,不同病理类型肾病对应用LMWH的总有效率达 87 5 % ,其中以MCNS和MsPGN者疗效最好 ,FSGS疗效较差。LMWH治疗前后血液全血粘度低、中、高切变率 ,全血还原粘度低、中、高切变率 ,血浆粘度和红细胞聚集指数均有明显改善 ,36例使用LMWH的难治性肾病患儿均有皮下淤血 ,1例出现血尿。结论 LMWH可降低难治性肾病的高凝状态 ,减轻蛋白尿 ,减少或减轻血栓等并发症的形成 ,宜尽早使用 ,以利于疾病的恢复。

Objective To observe the effect of low molecular weight heparin on refractory nephrotic syndrome accompanied with hypercoagulable state.Methods Under the fundamental therapy,low molecular weight heparin was given by percutaneous injectioon at the dose of 100～120AXaIU/kg/d for two weeks.Results After two weeks, treatment with low molecular weight heparin,average efficiency rate in different pathologic types was 87 5%.Among these types minimal change nephrotic syndrome(MCNS) and mesangial proliferative glomerulonephritis(MsPGN) gave better results,while few cases of focal segmemtal glomerulosclerosis(FSGS) responded well.After the usage of low molecular weight heparin,the lower,middle and higher tangential variation rates of the viscosity of the whole blood and of the reduction viscosity of the whole blood,the viscosity of plasma and aggregation index of RBC were markedly reduced.In all the 36 patients subcutaneous gore appeared with only one case of hematuria.Conclusion Low molecular weight heparin conjugating with other drugs had speeded up the remission of symptoms,such as hypercoagulable state,thrombosis,hematuria,without any noticeable side effect.So it is a safe and effective drug.