低分子肝素治疗难治性肾病综合征的疗效观察(附35例分析)

Therapeutic effect of LMWH on refractory nephrotic syndrome

目的 观察低分子肝素对难治性肾病综合征伴高凝状态的疗效。方法 35例难治性肾病综合征患者 ,随机分为两组 ,对照组用强的松、洛汀新潘生丁、雷公藤多甙、环磷酰胺以及利尿、对症等治疗 ;治疗组在对照组治疗基础上 ,加用低分子肝素 5 0 0 0 IU皮下注射 1次 /日 ,疗程 2个月。结果 治疗 8周后治疗组 FXa明显降低 ,与对照组比较差异显著 (P<0 .0 5 ) ;治疗组尿蛋白明显减少 ,血清 TP、AL B明显升高 ,其中尿蛋白、AL B的变化与对照组比较差异显著 (P<0 .0 5 ) ;血清 TG、 TCHO、 HDL、 L DL均有不同程度的下降 ,其中 TG、 TCHO与对照组比较差异显著 (P<0 .0 5 ) ;血清 BU N、Cr变化差异无显著性 (P>0 .0 5 )。治疗组 11例出现皮下瘀斑 ,未见其它副作用。治疗 1年后治疗组有效率、复发率明显低于对照组 (P<0 .0 5 )。结论 本研究提示 L MWH配合 CTX及适量激素治疗可使难治性肾病综合征患者的高凝状态缓解、尿蛋白减少、血清 TP、 AL B上升 ,从而使病情缓解 。

Objective to investigate the effects of LMWH in patients with refractory nephrotic syndrome.Methods 35 patients with refractory nephrotic syndrome with were randomized into 2 groups.The patients in the control were given steroid,CTX,persantine,Tripterygium glycosidesand,bennazipril,diuretic;the treatment group was given with LMWH(fragmin)of 5000IU/d beside the medicine used in the control group.Results A significant decrease of plasm FX a activity was observed in the treatment group compared with those in the control group after 8 weeks of treatment(P<0 05),a significant decrease in proteinuria and increase serum ALB in the treatment group compared with those in the control group(P<0 05),only 11 of the 21 patients complained of microdose hematoma under skin.A significant decrease of recurrence rate was observed in the treatment group compared with those in the control group after 1 year of treatment(P<0 05).Conclusion our data indicated that LMWH can decrease the proteinuria and increase serum ALB in adult NS patients with high thrombotic risk,and it is helpful to relieve refractory NS,and decrease relapse of refractory NS.