低分子肝素钙联合普通肝素钠抗凝治疗对原发性肾病综合征患儿尿蛋白和高凝状态的影响

Effect of anticoagulant therapy using low-molecular-weight heparin calcium combined with common heparin sodium on urinary protein and hypercoagulability in children with primary nephrotic syndrome

目的探讨低分子肝素钙联合普通肝素钠抗凝治疗对原发性肾病综合征患儿尿蛋白和高凝状态的影响。方法纳入60例原发性肾病综合征患儿,随机分为对照组、研究1组、研究2组,各20例。在常规糖皮质激素治疗的基础上,对照组不接受抗凝治疗,而研究1组、研究2组分别接受低分子肝素钙、低分子肝素钙联合普通肝素钠治疗。比较治疗前后3组患儿的24 h尿蛋白、血浆白蛋白水平、凝血功能,并观察3组患儿药物不良反应的发生情况。结果治疗4周后,与对照组比较,研究1组和研究2组的24 h尿蛋白定量、纤维蛋白原均更低,血浆白蛋白水平均更高,活化部分凝血活酶时间更长,且研究2组的24 h尿蛋白定量、纤维蛋白原均低于研究1组(均P <0. 05)。所有患儿均未出现药物不良反应。结论使用低分子肝素钙和普通肝素钠联合抗凝,可更有效地降低肾病综合征患儿的尿蛋白水平,改善其高凝状态,且不会增加出血风险。

Objective To investigate the effect of anticoagulant therapy with low-molecular-weight heparin calcium in a combination of common heparin sodium on the urinary protein and hypercoagulability in the children with primary nephrotic syndrome.Methods Sixty children with primary nephrotic syndrome were randomly divided into control group,study group 1,and study group 2,with 20 cases in each group.Based on conventional glucocorticoid treatment,study group 1 and study group 2 were treated with low-molecular-weight heparin calcium and low-molecular-weight heparin calcium combined with common heparin sodium,respectively,but no anticoagulant therapy was conducted in the control group.Before and after treatment,24 h urinary protein,plasma albumin and coagulation function were compared between the three groups,and incidence of adverse drug reactions during therapy was observed.Results After 4 weeks of treatment,24 h urinary protein quantity and fibrinogen were less,plasma albumin was higher,and activated partial thromboplastin time was longer in study groups than in the control,with 24 h urinary protein quantity and fibrinogen the least in study group 2(all P<0.05).No adverse drug reactions were observed in any children.Conclusion For the children with primary nephrotic syndrome,anticoagulant therapy of low-molecular-weight heparin calcium combined with common heparin sodium can significantly reduce the urinary protein and improve the hypercoagulability without increasing risk of hemorrhage.