静脉输注人血白蛋白对肾病综合征的正负临床效应观察

A study on the effects of human albumin infusion in minimal change nephrotic syndrome

目的 探讨静脉输注人血白蛋白 (HAI)对微小病变肾综合征 (MCNS)临床过程的正负效应。方法 63例MCNS分为大剂量HAI组 (A组 ,HAI≥ 2 0g d) 2 2例 ,小剂量HAI组 (B组 ,HAI≤ 10g d) 2 1例及未用HAI组2 0例 (C组 )。观察尿蛋白排出量 (UPE)、血浆白蛋白水平 (Alb)、HAI累积时间、HAI总量、缓解时间及 2年内复发率。结果 A组达到临床缓解所需时间明显长于其它两组 (P <0 0 1) ,且与HAI的治疗时间 (P <0 0 1)及使用总量 (P <0 0 1)呈正相关。B组及C组的临床缓解所需时间相近。A组治疗后UPE明显增加 (P <0 0 5 ) ,血浆Alb无明显变化 ,而B组治疗后UPE及血浆Alb均无变化 (P >0 0 5 ) ,2年内复发率分别为A组 62 5 % ,B组2 0 0 %及C组 2 5 0 %。结论 HAI治疗MCNS对临床过程产生的正性或负性效应主要取决于HAI的使用剂量及时间 ,大剂量HAI弊多利少 。

Objectives To explore the effects of human albumin infusion(HAI) on the clinical course of minimal change nephrotic syndrome(MCNS). Methods 63 cases with MCNS were divided into the large dose group(group A, 22 cases, HAI≥20g/d),the small dose group of human albumin infusion(group B, 21 cases, HAI≤10g/d) and the group of no albumin infusion(group C, 20 cases).Urinary protein excreation, serum albumin level, the time and total dose of HAI, the remission time and relapsing rate within 2 years were observed in this study.Results The clinical remission period in group A,which correlated positively with the treatment time (P<0 01) and total dose (P<0 01) of HAI,was significantly longer than that in group B and C(P<0 01).The clinical remission period in group B was similar to that in group C.Following HAI therapy, the UPE increased remarkarly (P<0 05) while serum albumin changed little in group A;Both UPE and serum albumin had no significant change in group B.The proportion of relapse were 62 5% in group A,20 0% in group B and 25 0% in group C respectively in two years.Conclusions The favorable or unfavorable effects of HAI therapy on the clinical course in MCNS depend on the dose and time of the treatment .Small dose of HAI therapy will benefit the patients,while large dose might produce more adverse effects.