低分子肝素钙治疗重症肾病综合征的临床探讨

Clinical effect of low-molecular-weight heparin calcium on severe nephrotic syndrome

目的探讨低分子肝素钙(LMWH)治疗原发性重症肾病综合征(PSNS)的疗效。方法将40例临床诊断为PSNS的患者随机分成治疗组(21例)和对照组(19例),两组的基本治疗药物是强的松及非诺贝特。在基本治疗的基础上,治疗组应用低分子肝素钙5 000 U·d-1皮下注射,对照组应用双嘧达莫50 mg囗服,3次/d,疗程均为4周。观察两组血纤维蛋白原(FIB)、24 h尿蛋白、血清肌酐(Scr)、血清白蛋白(ALB)、血总胆固醇(TCHO)、甘油三酯(TG)、血小板(PLT)、凝血酶原时间(PT)、白陶土部分凝血酶时间(APTT)的水平变化。结果与对照组相比,治疗组治疗后FIB、TCHO、TG、24 h尿蛋白明显下降(P<0.05),ALB明显上升(P<0.05);Scr治疗后组间差异无统计学意义(P>0.05)。除治疗组有2例皮下出现瘀斑外,余未见其它副作用。结论在糖皮质激素的基础上加用LMWH治疗PSNS,可使患者的高凝状态明显缓解,防止血栓形成,并使TCHO、TG、尿蛋白明显下降,血清ALB上升,不仅使病情缓解,而且副作用较少。

Objective To investigate the effects of low-molecular-weight heparin calcium （LMWH） in pa- tients with primary severe nephritic syndrome （PSNS）. Methods Forty patients~ with PSNS were divided randomly in- to treated groups （n = 21 ） which was treated with LMWH of 5 000 U·d^-1 injection under skin and control group（ n = 19） which was treated with Dipyridamole 50 mg three times every day for 4 weeks. Two groups were treated with the same base of steroid and Fenofibrate. Plasma FIB, 24 h urinary protein, Scr, ALB, TCHO, TG, PLT, PT and APTY were observed. Results A significant decrease of plasma FIB, serum TCHO and TG was observed in the treated group compared with those in the control group after 4 weeks of treatment（ P 〈 0.05 ）. A significant decrease of 24 h urinary protein and increase of serum ALB was observed in the treated group compared with those in the control group after 4 weeks of treatment（ P 〈 0. 05 ）. Only 2 of the 21 patients in treated group complained of ecchymosis under skin. Conclusion The treatment with LMWH for PSNS can significantly decrease plasma FIB and protect against high thrombotic risk of PSNS, LMWH for PSNS can significantly decrease 24 h urinary protein, serum TCHO, TG and increase serum ALB, and it is helpful to relieve PSNS.