妊娠期肾病综合征应用蛋白支持疗法进行综合治疗的疗效分析

Analysis on the curative effect of comprehensive treatment with protein support therapy for gestational nephrotic syndrome

目的:研究对妊娠期肾病综合征患者采用蛋白支持疗法的临床疗效及安全性,为临床治疗妊娠期肾病综合征提供参考意见。方法:将该院妇产科收治的妊娠期中、重度子痫患者206例,其中合并妊娠肾病综合征的患者72例随机分为治疗组40例,对照组32例;治疗组采用控制血压和补充人血白蛋白(每日剂量<15 g)的治疗方法,对照组仅采用控制血压等措施,比较两组患者治疗效果及并发症和妊娠结局情况。结果:治疗组平均舒张压(DBP)、平均收缩压(SBP)、24 h尿蛋白、白蛋白、尿酸(Ua)、肌酐(Cr)治疗前后数据差异具有统计学意义(P<0.05);对照组SBP、DBP、血清总蛋白、白蛋白、Ua、Cr水平治疗前后比较差异具有统计学意义(P<0.05);治疗组由于输注白蛋白,所以24 h尿蛋白、血清总蛋白、白蛋白、Ua、Cr水平均比治疗前升高,对照组只采用降压治疗,血压得到一定的控制,但是人体内血清总蛋白、白蛋白水平均下降;治疗后两组比较:两组间24 h尿蛋白、血清总蛋白、白蛋白水平在两组间存在差异,治疗组明显高于对照组,差异具有统计学意义(P<0.05);水肿消退平均时间治疗组长于对照组,出生体重治疗组优于对照组,两组差异具有统计学意义(P<0.05),其他指标比较不具有统计学意义(P>0.05)。结论:对妊娠期肾病综合征患者进行蛋白支持治疗对改善患者肾功能、减轻妊娠并发症及减轻妊娠结束后水肿没有作用甚至会加重肾的负担,但是对于胎儿发育有一定作用。

Objective： To research the clinical efficacy and safety of protein support therapy for patients with gestational nephrotic syndrome, provide reference for clinical treatment of gestational nephrotic syndrome. Methods ： A total of 206 patients with moderate and severe preeclampsia were treated in gynecological and obstetrical department of the hospital, and 72 patients of them were diagnosed as gestational nephrotic syndrome, then the patients were divided into treatment group （40 patients） and control group （32 patients） ; the patients in treatment group were treated with blood pressure control and human serum albumin supplementation （dose every day was less than 15 g）, while the patients in control group were only treated with blood pressure control; the curative effects, complications and pregnancy outcomes in the two groups were compared. Results： There were statistically significant differences in mean diastolic blood pressure （ DBP）, mean systolic blood pressure （SBP）, 24 -hour urine protein, albumin, uric acid and creatinine levels between before and after treatment in treatment group （ P 〈 0. 05 ） ; there were statistically significant differences in mean SBP, mean DBP, total serum protein, albumin, uric acid and creatinine levels between before and after treatment in control group （ P 〈 0. 05 ） ; 24 - hour urine protein, total serum protein, albumin, uric acid and creatinine levels after treatment in treatment group increased compared with before treatment because of infusion of albumin; while in control group, total serum protein and albumin levels after treatment decreased because only blood pressure control was given to the patients ; after treatment, 24 - hour urine protein, total serum protein and albumin levels in treatment group were statistically significantly higher than those in control group （ P 〈 0. 05 ） ; the mean fade time of edema in treatment group was statistically significantly longer than that in control group （ P 〈 0. 05 ）, birth weight in treatment group was statistically significantly weighter than that in control group （ P 〈 0.05 ）, there was no statistically significant difference in the other indexes between the two groups （ P 〉 0.05 ） . Conclusion： Protein support treatment for patients with gestational nephrotic syndrome has no impact on renal function, relieve pregnancy complications and postpartum edema, it even aggravate the burden of kidney, but it plays a certain role in fetal development.