【摘要】 目的　观察低分子肝素 (LMWH)治疗难治性肾病综合征临床疗效、抗凝效果及安全性。方法　 3 3例伴高凝状态的原发性肾病综合征患者随机分为两组 ,对照组予强的松 1mg/kg/天 +环磷酰胺 5 0mgBid口服 +甲基强的松龙 0 5～ 1g(2 0mg/kg/次 )加入 5 %葡萄糖液 2 5 0ml静脉点滴 ,治疗组在对照组治疗方案基础上加LMWH5 0 0 0IU皮下注射每天两次 ,共观察 4周 ,治疗前后均观察临床症状体征及 2 4h尿蛋白定量和肾功能的变化 ,并检测血浆抗凝血酶Ⅲ (AT -Ⅲ )活性、血纤维蛋白原 (FIB)、D -二聚体 (DD)、血浆因子Xa因子 (FXa)活性、血浆因子IIa(FIIa)活性。结果　治疗 4周后两组患者 2 4小时尿总蛋白、尿素氮 (BUN)、血肌酐 (Cr)明显下降 (P <0 0 5 ) ,血清白蛋白 (ALB)、内生肌酐清除率 (Ccr)明显升高 (P <0 0 5 ) ,但治疗组中 2 4h尿总蛋白下降显著大于对照组(P <0 0 5 ) ,血清白蛋白上升显著高于对照组 (P <0 0 5 ) ,治疗组治愈率和显效率明显高于对照组 (P <0 0 5 ) ,无效率明显低于对照组 (P <0 0 5 )。治疗组中AT -III活性明显升高 (P <0 0 5 ) ,FIB、DD、FXa活性明显降低 (P <0 0 5 ) ,FIIa无明显变化 ,无一例并发深静脉血栓形成 ,对照组中上述指标无明显变化 ,且 4例出现深静脉血栓形成。结论　在更多还原

【Abstract】 Objective To observe the clinical efficacy and anticoagulant effects and safety of low-molecular-weight heparin (LMWH) on treatment of refractory nephrotic syndrome(NS).Methods 33 patients of primary NS complicated with hypercoagulability were randomly divided into two groups: the control and the treatment groups. The control group was treated with prednisolone(1mg/kg/d) plus oral cyclophosphamide (50mg bid) and methylprednisolone 0 5～1g(20mg/kg/time) in glucose 250ml(5%) intravenously by drip . While the treated group was administered, on the basis of the therapeutic scheme of the control group, with subcutaneous injection of LMWH (5000IU bid) for 4 weeks, the clinical symptom was observed in both groups before and after the treatment ,the 24h urine protein quantitative determination,renal function,anti thrombin III (AT-III) activity,fibrinogen(FIB),D-dimer(DD),plasma factor Xa( Fxa),plasma factor IIa(FIIa) were also tested, the side effects in two groups were observed at the same time. Results The 24h urine protein quantitative determination,blood urea nitrogen(BUN) and serum Cr were significantly decreased(P<0 05)in both groups ,whereas the serum albumin(ALB) and the endogenous creatinine clearance rate(Ccr)were obviously increased(P<0 05) after four weeks treatment in the two groups . But the decrement in the 24h proteinuria and the improvement of the ALB in the treated group were higher,as compared with those in the control group(P<0 05), and the healing rate and excellent effective rate in the treatment group was higher than those in the control group(P<0 05), and the inefficiency rate in the treatment group was lower than that in the control group(P<0 05).A significant improvement in AT-III activity (P<0 05) and decrement in FIB,DD,FXa(P<0 05) and no significant changes in FIIa were observed in the treatment group,not any intravenous thrombosis was found in these patients. In the control group, no significant change in these markers was found, and deep venous thrombosis was found in 4 patients.Conclusions On the basis of the prednisolone plus cyclophosphamide treatment,the LMWH can relieve the hypercoagulability ,improve renal function and decrease the thrombotic complications of patients with refractory nephrotic syndrome .更多还原