速避凝和肝素治疗儿童难治性肾病的疗效对比观察

Comparison of effects of low molecule weight heparin and heparin on refractory nephrotic syndrome

目的 使用速避凝 (LMWH)治疗 36例难治性肾病 ,并与肝素 (SH)治疗 2 1例难治性肾病的疗效进行对比。方法 LMWH每次 0 0 10～ 0 0 12ml/kg ,1次 /d ,14d为一疗程 ;SH每次 1mg/kg ,1次 /d ,10～ 14d为一疗程。 结果 LMWH组尿蛋白转阴 2 1例 (5 8 3% ) ,尿蛋白减少 + +以下 11例 (30 6 % ) ,无效 4例 (11 1% ) ,总有效率 88 9% ;而SH组尿蛋白转阴 13例 (6 1 9% ) ,尿蛋白减少 + +以下 1例 (4 8% ) ,无效 7例 (33 3% ) ,总有效率 6 6 7% ;病理类型两组均以MCNS和MsPGN疗效最好 ,FSGS疗效较差。结论 LMWH和SH均有助于难治性肾病的缓解、降低高凝状态而无明显的副作用 ,但LMWH与SH相比 ,其生物利用度好 ,半衰期长 ,出血危险性小 ,且无血小板减少、肝功能损害、脱发、骨质疏松等副作用 ,是治疗儿童难治性肾病高凝状态的理想药物。

WT5”BZ] Objective To analyze the therapeutic effects of low-molecule weight heparin(LMWH)and heparin on refractory nephrotic syndrome(RNS) accompanied with hypercoagulable state. Methods LMWH(0.010～ 0.012 ml/kg )or heparin( 1 mg/kg ) was given patients with RNS by subcutaneous injection once a day for 14 days.Bleeding time,coagulable time and thrombin time were measured weekly. Results Thirty-two patients in LMWH group were diagnosed by renal biopsy.The pathological types were 5 minimal change nephrotic syndrome(MCNS),17 mesangial proliferative glomerulonephritis(MsPGN),6 membranous proliferative glomerulonephritis (MPGN) and 4 focus segmental glomerulosclerosis (FSGS).Following the treatment with LMWH for 2 weeks in 36 patients,proteinuria of 21 turned negative,of 11 reduced by 2+and less,and of 4 unchanged.The total effective rate reached 88.9% in FSGS,especially in MCNS and MsPGN.All patients treated with LMWH had subcutaneous gore,and only one hematuria,Twenty-one in heparin group were diagnosed as follows, 3 patients with MCNS,10 MPsGN, 3 MPGN and 5 FSGS,treated with heparin for 10 to 14 days.Proteinuria turned negative in 16,reduced by 2+ and less in 2,and unchanged in 5.Its total effective rate reached 76 2%.As in the LMWH group,better effects were got in MCNS and MsGN than in FSGS.All patients showed no side effects except 3 cases of nose bleeding. Conclusion Both LMWH and heparin are helpful to relieve refractory nephrotic syndrome,reduce hypercoagulable state,and prevent thrombosis and other complications,and they have no obvious side-effects. But when comparing to heparin,LMWH has the higher therapeutic effects,fewer complications,and more safety.