贺斯、白蛋白和低分子右旋糖苷对128例并发重度水肿的原发性肾病综合征患者利尿效果及肾损害的对照观察

Efficacy analysis about diuresis and renal injury of HAESS-teril,albumin and low molecule dextran in 128 primary nephrotic syndrome patients

目的观察贺斯、白蛋白和低分子右旋糖苷对合并重度水肿的原发性肾病综合征利尿效果及对肾小管损害的影响。方法 2010年8月至2011年8月在甘肃省人民医院及解放军兰州军区兰州总医院肾内科住院的128例合并重度水肿的原发性肾病综合征患者分为3组,在足量激素治疗的基础上,分别予以贺斯、人血白蛋白及低分子右旋糖苷静滴10天。观察10天内3组患者每日尿量及体质量;检测治疗前、第7天、14天尿肾损伤因子1(KIM-1)及尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)水平;随访治疗后8周完全缓解率、部分缓解率和总体缓解率。结果在用药1～3天,白蛋白组尿量增加及体质量下降最明显,在第4～8天贺斯组尿量增加及体质量下降与白蛋白组相似,第9～10天3组尿量及体质量相似;治疗前,3组尿KIM-1及尿NAG酶水平相似,但治疗后第7天,白蛋白组和低右组尿KIM-1及尿NAG酶水平开始升高,第14天更明显,白蛋白组和低右组在第7天和第14天均高于贺斯组且差异有统计学意义,贺斯组在治疗前和治疗后尿KIM-1及尿NAG酶水平差异无统计学意义。在第8周随访结果显示贺斯组总体缓解率好于白蛋白组和低右组。结论贺斯具有较稳定的利尿作用和减轻体质量作用,未见明显肾损伤,总体缓解率较高,是比较理想的PNS扩容利尿药。

Objective To observe the clinical diuresis effect and renal injury of HAESS-teril,albumin and low molecule dextran on severe edema in nephrotic syndrome.Methods 128 cases of nephrotic syndrome patients with severe edema from August 2010 to August 2011 were divided into three groups.On premise treatment of big dose,HAESS-teril,albumin and low molecule dextran were used in 10 days respectively.The patients’ urine volume and body mass were surveyed in 10 days;the level of urine kidney injury molecule（KIM-1） and N-acetyl-β-glucosaminase（NAG） were detected in beginning,7 days,14 days respectively;and completely recovery rate,partly recovery rate and totally recovery rate were followed up after 3 months.Results At first 3 days,albumin group had the most obvious increase of urine volume and decrease of body mass;but at 11 to 14 days,the HAESS-teril group had the most obvious change;at last 2 days,the three groups all had similar condition.In beginning,three groups had the same level of urine KIM-1 and NAG,but in day 7 after treatment,the changes were more distinct.At last,HAESS-teril group had the best total recovery rate after 8 weeks of treatment.Conclusion Possessed steady diuretic effect and without kidney toxicity,HEASS-teril may be a better choice to nephrotic syndrome patients with severe edema.