小剂量低分子肝素钠辅助治疗儿童原发性肾病综合征的临床疗效

The Clinical Effects of Low-Dose Low-molecular-weight Heparin as Auxiliary Treatment for Children with Primary Nephrotic Syndrome

目的探讨小剂量低分子肝素钠辅助治疗原发性肾病综合征患儿的临床疗效。方法选取广州中医药大学金沙洲医院2015年6月至2017年8月收治的80例原发性肾病综合征患儿作为研究对象,按随机数字表法分为联合组和常规组,各40例。联合组给予口服泼尼松治疗联合皮下注射小剂量低分子肝素钠治疗,常规组给予口服泼尼松治疗。检测两组患儿治疗前后血清白蛋白、总胆固醇(TC)、三酰甘油(TG)、24 h尿蛋白定量、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、血肌酐(SCr)、内生肌酐清除率(Ccr)和尿素氮(BUN)等指标变化,比较两组患儿治疗有效率和不良反应发生率。结果治疗后两组患儿血清白蛋白、Ccr较治疗前明显增高,且联合组较常规组增高更为明显,差异有统计学意义(P<0.05);两组患儿的TC、TG、24 h尿蛋白定量、SCr、BUN较治疗前明显下降,且联合组较常规组下降更为明显,差异有统计学意义(P<0.05);两组患儿的APTT和PT与治疗前比较,差异无统计学意义(P>0.05);联合组治疗有效率为95.00%,明显高于对照组的77.50%,差异有统计学意义(P<0.05);两组患儿不良反应发生率比较差异无统计学意义(P>0.05)。结论小剂量低分子量肝素钠辅助常规激素治疗原发性肾病综合征,能够明显改善患儿肾功能,降低血脂,提高治疗有效率,且不影响患儿的凝血功能,不增加不良反应发生率。

Objective To explore the clinical effects of low-dose low-molecular-weight heparin as auxiliary treatment for children with primary nephrotic syndrome(NS). Methods A total of 80 children with NS were randomly divided into combined group(40) and regular group group(40). The combined group was given a small dose of low molecular heparin combined with oral prednisone, while the regular group was given oral prednisone. The serum albumin, total cholesterol(TC), triacylglycerol(TG), 24 h urine protein, changes in activated partial thromboplastin time(APTT), prothrombin time(PT), serum creatinine(SCr), endogenous creatinine clearance(Ccr) and urea nitrogen(BUN) etc., were recorded.The total effective and the incidence of adverse reactions were compared between the 2 groups of children. Results After treatment, serum albumin and Ccr in the 2 groups were significantly higher than those before treatment, and those in combine group was more higher than regular group(P<0.05);The TC, TG, 24 h urinary protein quantification, BUN of 2 groups were significantly lower after treatment, and combine group was more significant than regular group(P<0.05);There was no differences in APTT and PT between 2 groups after treatment(P>0.05). The effective rate of combined group was 95.00%, which was significantly higher than control group(77.50%)(P<0.05). There was no difference in the incidence of adverse reactions between the 2 groups(P>0.05). Conclusion Low-dose low-molecularweight heparin sodium assisted with conventional hormone in the treatment of primary nephrotic syndrome can significantly improve the renal function, reduce blood lipid, improve the treatment efficiency, nor affect the coagulation function of children, nor increase the incidence of adverse reactions.