肝素疗法治疗肾病综合征并急性肾功能衰竭的临床观察

Heparin regimen in the treatment of nephrotic syndrome associated with acute renal failure

为探讨肝素在肾病综合征 (NS)并急性肾功能衰竭 (ARF)中的治疗作用 ,将 38例NS并ARF患者随机分为对照组(A组 ) 18例 ,治疗组 (B组 ) 2 0例 ,A组常规综合治疗 ,B组在A组治疗基础上静脉滴注肝素钠 1个疗程 10天 ,观察两组仍少尿例数 ,需血透例数 ,尿蛋白、血脂、肾功能、肾有效血流量以及B组用药前后血液流变学指标变化。结果显示 :B组比A组少尿及需血透例数 ,血尿素氮、血肌酐显著减少 ,肾有效血流量显著增加 (P均 <0 .0 5 ) ,尿蛋白、血脂的差异无显著性(P >0 .0 5 )。B组治疗后比治疗前除红细胞比容外血液粘滞性下降差异有高度显著性 (P <0 .0 1)。认为肝素疗法治疗NS并ARF有明显疗效 。

In order to prospectively study the effect of heparin on the treatment of nephrotic syndrome(NS) associated with acute renal failure (ARF), 38 patients with this disease were randomly divided into the control group (group A, 18 cases) and the therapeutic group (group B, 20 cases). Group A received the routine combined therapy. Besides receiving the same regimen as group A, group B also received a 10 day course of intravenous heparin. The two groups were evaluated according to the number of cases with oliguria requiring hemodialysis, urinary protein, blood-lipid levels, renal function and effective renal plasma flow (ERPF). In group B, the index changes of blood rheology before and after treatment were also observed. Results indicated that the number of cases with oliguria requiring hemodialysis, blood urea nitrogean and serum creatinine decreased dramatically in group B than those in group A, the ERPF increased significantly in group B (P<0.05), and there was no statistical difference between urinary protein and blood-lipid levels in the two groups (P>0.05). Excluding hematocrit, there was a statistical significant difference in the decrease of blood viscosity before treatment than after it, excluding hematocrit (P<0.01). This study indicates that heparin therapy had a better efficacy in the treatment of NS associated with ARF.