低分子肝素联合泼尼松治疗小儿肾病综合征的疗效观察

Clinical observation on therapeutic effects of low molecular heparin combined with prednisone on children with nephrotic syndrome

目的探讨不同剂量低分子肝素联合泼尼松对肾病综合征患儿肾功能和凝血指标的影响,及小儿肾病综合征低分子肝素治疗的优选剂量。方法选择2015年1月至2016年12月在沧州市中心医院住院治疗的原发性肾病综合征患儿46例,根据治疗方案不同其分为低剂量组和高剂量组各23例,两组给予相同的泼尼松治疗方案,低剂量组给予低分子肝素钠50~100IU·kg-1·d-1治疗,高剂量组给予低分子肝素120~150IU·kg-1·d-1治疗,均以2周为1个疗程。观察两组治疗前和1个疗程后24h尿蛋白、血清肌酐(SCr)、尿素氮(BUN)、血肌肝清除率(Ccr)、白蛋白(ALB)、血小板(PLT)、D-二聚体(D-D)、纤维蛋白原(FIB)、部分活化凝血酶时间(APTT)和凝血酶原时间(PT)水平,统计两组治疗期间的并发症发生情况。结果治疗1个疗程后两组24h尿蛋白、SCr、BUN、D-D、FIB均较治疗前显著降低(低剂量组:t值分别为9.083、6.328、4.025、6.133、3.926;高剂量组:t值分别为9.513、6.438、4.287、5.670、4.118,均P<0.05);Ccr、ALB、APTT和PT均较治疗前显著升高(低剂量组:t值分别为5.371、5.823、4.208、3.714;高剂量组:t值分别为9.513、6.137、4.548、3.875,均P<0.05);PLT与治疗前相比较差异无统计学意义(低剂量组:t=0.484;高剂量组:t=0.577,均P>0.05)。两组治疗前、后上述指标组间相比较差异均无统计学意义(治疗前组间比较t值分别为0.542、0.671、0.408、0.322、0.399、0.632、0.711、0.448、0.549、0.817;治疗后组间比较t值分别为0.608、0.532、0.511、0.437、0.508、0.512、0.609、0.470、0.744、0.776,均P>0.05)。高剂量组并发症发生率高于低剂量组(χ2=4.212,P<0.05)。结论两种剂量低分子肝素联合泼尼松治疗小儿肾病综合征临床效果无差异,但低剂量组具有更低的并发症发生率,是治疗小儿肾病综合征的优选剂量。

Objective To discuss the effect of different doses of low molecular heparin combined with prednisone on renal function and blood coagulation indexes in children with nephrotic syndrome and to explore the optimal dose of low molecular heparin for children with nephrotic syndrome.Methods According to different treatment options,46 children with nephrotic syndrome were divided into low dose group and high dose group with 23 cases in each group.The children in 2 groups were given the same treatment plan of prednisone.The children in the low dose group were treated with low molecular heparin sodium 50-100 IU·kg-1·d-1,while the children in the high dose group were treated with low molecular heparin 120-150 IU·kg-1·d-1,with2 weeks as a course of treatment.The 24 hurine protein,serum creatinine（SCr）,urea nitrogen（BUN）,serum creatinine clearance rate（Ccr）,albumin（ALB）,platelet（PLT）,D-Dimer（D-D）,fibrinogen（FIB）,activated partial thromboplastin time（APTT）and prothrombin time（PT）levels in two groups before and after 1 course of treatment were observed,and the incidence of complications in two groups during treatment was recorded.Results After 1 course of treatment,the 24 hurine protein,SCr,BUN,D-D and FIB in two groups were significantly lower than those before treatment（in low dose group：t value was 9.083,6.328,4.025,6.133 and 3.926,respectively;in high dose group：t value was 9.513,6.438,4.287,5.670 and 4.118,respectively,all P0.05）,while the Ccr,ALB,APTT and PT in two groups were significantly higher than those before treatment（in low dose group：t value was 5.371,5.823,4.208 and 3.714,respectively;in high dose group：t value was 9.513,6.137,4.548 and 3.875,respectively,all P0.05）.Comparison between groups showed no significant difference in PLT before and after treatment in（low dose group：t=0.484;in high dose group：t=0.577,both P0.05）.There was no significant difference in above indexes before and after treatment between two groups（before treatment,t value was 0.542,0.671,0.408,0.322,0.399,0.632,0.711,0.448,0.549 and 0.817,respectively;after treatment,t value was 0.608,0.532,0.511,0.437,0.508,0.512,0.609,0.470,0.744 and0.776,respectively,all P0.05）.The incidence of complications in high dose group was higher than that in low dose group（χ2=4.212,P0.05）.Conclusion There is no difference in clinical effect of 2 doses of low molecular heparin combined with prednisone on the treatment of children with nephrotic syndrome.But with lower incidence of complications,low dose is the optimal dose for treatment of children with nephrotic syndrome.