目的 探討不同劑量低分子肝素聯(lián)合潑尼松治療難治性腎病綜合征的臨床療效。方法 選取2012年9月-2014年4月岳陽市一人民醫(yī)院收治的難治性腎病綜合征患者128例,隨機(jī)分為對照組和低分子肝素大、中、小劑量組,每組32例。對照組口服醋酸潑尼松片1 mg/(kg·d),8周后逐漸降至維持量5～10 mg/d。低分子肝素大、中、小劑量組在對照組的基礎(chǔ)上sc低分子肝素鈣注射液3 075 U/次,大劑量組2次/d;中劑量組1次/d;小劑量組隔日1次。4組患者均連續(xù)治療6個月。觀察4組的臨床療效,同時比較4組患者24 h尿蛋白定量、血漿白蛋白(ALB)、肌酐(CREA)、凝血酶原時間(PT)、活化部分凝血活酶時間(APTT)、血漿纖維蛋白原(FIB)、三酰甘油(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、總膽固醇(TC)的變化。結(jié)果 治療后,對照組和低分子肝素大、中、小劑量組緩解率分別為65.0%、95.0%、85.0%、70.0%,大、中劑量組的緩解率明顯高于對照組;大劑量組的緩解率明顯高于中、小劑量組,差異有統(tǒng)計學(xué)意義(P<0.05)。4組患者24 h尿蛋白定量均較治療前顯著降低,ALB顯著升高,同組治療前后差異有統(tǒng)計學(xué)意義(P<0.05);大、中、小劑量組患者CREA均較治療前顯著降低,差異有統(tǒng)計學(xué)意義(P<0.05);且大劑量組24 h尿蛋白定量、ALB、CREA的改善程度優(yōu)于其他3組,差異有統(tǒng)計學(xué)意義(P<0.05)。大、中、小劑量組TG、TC、LDL均顯著降低,同組治療前后差異有統(tǒng)計學(xué)意義(P<0.05);且大、中、小劑量組的改善程度優(yōu)于對照組,差異有統(tǒng)計學(xué)意義(P<0.05)。低分子肝素大、中、小劑量組PT、APTT均較治療前明顯延長,其中大劑量組高于中、小劑量組(P<0.05);FIB較治療前明顯減少,且大劑量組FIB低于小劑量組(P<0.05)。結(jié)論 低分子肝素治療難治性腎病綜合征具有較好的臨床療效,可改善患者的高凝狀態(tài),尤其是大劑量組療效更佳。

Objective To explore the effect of different dosages of low molecular heparin combined with prednisone in treatment of refractory nephrotic syndrome. Methods The patients with refractory nephrotic syndrome (128 cases) of the First People's Hospital of Yueyang from September 2012 to April 2014 were randomly divided into control, large, medium and small dosage groups, and each group had 32 cases. The patients in the control group were po administered with Prednisone Acetate Tablets 1 mg/(kg·d). The dosage gradually fell to maintain level 5-10 mg/d after 8 weeks. The patients in low molecular heparin large, medium and small dosages groups were sc administered with Low Molecular Heparin Calcium Injection 3075 U/time on the basis of the control group, large dosage group twice daily; medium dosage group once daily; small dosage group once two days. Four groups were continuously treated for 6 months. After treatment, the clinical efficacy in four groups were evaluated, while the changes of 24 h urine protein quantity, ALB, CREA, PT, APTT, FIB, TG, LDL, HDL, and TC were compared. Results After treatment, remission rate in the control group, large, medium and small dosage groups were 65.0%, 95.0%, 85.0%, and 70.0%. The remission rate in large, medium dosage groups were obviously higher than that in control group, while remission rate in large dosage group was obviously higher than that in medium and small dosage groups, and the difference was statistically significant (P< 0.05). Urine protein quantity of 24 h in four groups significantly reduced, and ALB significantly elevated, and the differences were statistically significant before and after treatment in the same group (P< 0.05). CREA in large, medium and small dosage groups significantly reduced with the significant difference (P< 0.05). The improvement degrees of 24 h urine protein quantity, ALB, and CREA in large dosage group were better than the other three groups with the significant difference (P< 0.05). TG, TC, and LDL in large, medium and small dosage groups significantly reduced, and the differences were statistically significant before and after treatment in the same group (P< 0.05). The improvement degrees in large, medium and small dosage groups were better than control group with the significant difference (P< 0.05). PT and APTT in large, medium and small dosage groups were significantly longer, and those in large dosage group were longer than medium and small dosage groups (P< 0.05). FIB in three dosage groups were significantly reduced, and large dosage group was lower than the low dosage group (P< 0.05). Conclusion Low molecular heparin combined with prednisone has a good clinical efficacy in treatment of refractory nephrotic syndrome, and can improve the hypercoagulabale state, especially the curative effect of large dosage group is better.