银杏达莫联合来氟米特对肾病综合征患者高凝状态的影响及临床效果

Clinical effect of Yinxingdamo combined with leflunomide on hypercoagulable states in patients with nephrotic syndrome

目的:观察银杏达莫联合来氟米特治疗对原发性肾病综合征(PNS)患者高凝状态的影响、疗效及安全性。方法:2010年5月-2012年5月间的51例PNS患者随机分A组(14例)、B组(18例)和C组(19例),受试者均给予糖皮质激素治疗。A组加用银杏达莫治疗,B组加用来氟米特治疗,C组联合来氟米特和银杏达莫治疗。观察3组生化指标[24 h尿蛋白定量、血清白蛋白(ALB)、总胆固醇(TC)和血肌酐(SCr)]、凝血功能[血小板计数(PLT)、纤维蛋白原(FIB)、D-二聚体(DD)和活化部分凝血酶时间(APTT)]和临床疗效、不良反应。结果:(1)治疗前3组各项指标比较均无统计学差异(P>0.05);(2)治疗后,3组24 h尿蛋白定量、TC及SCr均降低(P<0.05),ALB升高(P<0.05),且B、C组变化较A组更显著(P<0.05);(3)治疗后,3组PLT、FIB、DD较治疗前均降低(P<0.05),但仅有C组APTT较治疗前升高(P<0.05);与A、B组比较,C组PLT、FIB、DD及APTT差异有统计学意义(P<0.05);(4)B组与C组疗效比较无统计学差异(Z=-0.293,P>0.05),但均优于A组(Z值为-2.067,-1.978,P<0.05);3组不良反应发生率比较无显著差异(χ2=0.034,P>0.05)。结论:银杏达莫联合来氟米特治疗能改善PNS患者高凝状态、生化指标和临床症状,且不良反应较少,安全性好。

OBJECTIVE To observe the effect on hypercoagulable state, clinical efficacy and safety of Yinxingdamo com- bined with leflunomide in patients with primary nephrotic syndrome （PNS）. METHODS From May 2010 to May 2012, 51 ea- ses of PNS patients were randomly divided into group A （n = 14 cases） ,group B （n = 18 cases） and group C（n = 27 cases）, all were treated with glucocortieoid. The group A was treated with Yinxingdamo, the group t3 was treated with leflunomide , and the group C was treated with Yinxingdamo combined with leflunomide. The biochemieal index [24 hour urinary protein excre- tion, serum albumin （ALB）, total eholesterol （TC） and serum creatinine （SCr）],coagulation functions [platelet count （PLT）, fibrinogen （FIB）, D-dimer （DD） and activated partial thromboplastin time （APTT）] and clinical efficacy, adverse reaetions were observed. RESULTS （1）All indexes among three groups were no significant difference before treatment （H〉0.05） ; （2） In three groups, the 24h urinary protein, TC and SCr were decreased （P〈0. 05）, and ALB was elevated after treatment （P〈 0. 05）, and the changes in the group B and group C were more significant as compared with group A （P〈0. I）5）. （3）PLT, FIB, DID of three groups were decreased after treatment （P〈0. 05）, but only APTT of group C was increased after treatment （P〈0. 05）. PLT, FIB, DD and APTT of group C were singinieant difference compared with group A and group B （P〈 0. 05）. （4）The clinieal＇effieacy had no significant difference between group B and group C （Z = - 0. 293, P〉0. 05）, but better than that of group A （Z= - 2. 067, - 1. 978, P〈0.05）. There was no significant difference in adverse reactions among three groups （Z2 = 0. 034, P〉0. 05）. CONCLUSION The therapy of Yinxingdamo combined with leflunomide on PNS could im prove hypercoagulable state, biochemical and elinieal symptoms, and had few adverse reactions and with good security.