【摘要】 目的　探讨华法林钠 (warfarin)和低分子肝素钙 (LMWH)对难治性肾病综合征 (RNS)患者高凝 -纤溶状态的抗凝效果与尿蛋白减少的关系。方法　将 78例血D - 2聚体 (D -D)阳性 ,凝血酶原时间 (PT) <11s的RNS患者 ,在常规激素治疗的基础上 ,随机分成 4组。 2组分别用正常量warfarin和LMWH抗凝 ,另 2组分别用加大剂量的warfarin和LMWH抗凝 ,以PT延长至正常值 1～ 1.5倍及 2～ 2 .5倍为度。全部患者疗程 4周 ,治疗前后测定血D -D及尿蛋白各 1次。结果　warfarin与LMWH在PT达正常值 1～ 1.5倍及 2～ 2 .5倍的各时段内 ,患者的血D -D转阴、尿蛋白消减 ,没有显著性差异。不同剂量warfarin在PT达正常值 1～ 1.5倍和 2～ 2 .5倍间 ,患者的尿蛋白消减有显著性差异。不同剂量LMWH在PT达正常值 1～ 1.5倍和 2～ 2 .5倍间 ,患者血D -D转阴、尿蛋白消减有显著性差异。warfarin比LMWH能更快地延长PT时间。结论　warfarin和LMWH能使RNS患者高凝-纤溶状态改善和尿蛋白消减 ,用药剂量以PT达正常值 2～ 2 .5倍为佳。warfarin比LMWH奏效快更多还原

【Abstract】 Objective\ To evaluated the effect of warfarin and low molecular weight heparin(LMWH) in patients with refractory nephrotic syndrome(RNS) accompanied with hypercoagulability and investigate the change of amount of urinary protein. Method\ 78 cases with RNS, who were positive serum D-dimer(D-D) and prothrombin time(PT) less than 11 seconds, were randomly divided into four groups. In which, two groups accepted normal dosage of warfarin or LMWH, had 1～1.5 times PT longer than normal for four weeks, other tow groups accepted larger dosage of warfarin or LMWH, had 2～2.5 times PT longer than normal for four weeks. All patients were administrated regular steroid therapy. Serum D-D and urinary protein were determined before and after the study. Result\ There were not significantly difference in serum D-D and urinary protein between warfarin and LMWH, including of 1～1.5 times and 2～2.5 times longer PT. There were significantly difference urinary protein between 1～1.5 times and 2～2.5 times longer PT in patients with warfarin. However in LMWH, were serum D-D and urinary protein. warfarin was more quickly to meet the ideal PT than LMWH. Conclusion\ Both warfarin and LMWH were to benefit of hypercoagulability and reduce of urinary protein in patients with RNS. The ideal PT was 2～2.5 times longer than normal. warfarin was more quickly to reach the aim PT that were needed.更多还原