目的 探讨不同剂量低分子肝素联合泼尼松治疗难治性肾病综合征的临床疗效。方法 选取2012年9月-2014年4月岳阳市一人民医院收治的难治性肾病综合征患者128例,随机分为对照组和低分子肝素大、中、小剂量组,每组32例。对照组口服醋酸泼尼松片1 mg/(kg·d),8周后逐渐降至维持量5～10 mg/d。低分子肝素大、中、小剂量组在对照组的基础上sc低分子肝素钙注射液3 075 U/次,大剂量组2次/d;中剂量组1次/d;小剂量组隔日1次。4组患者均连续治疗6个月。观察4组的临床疗效,同时比较4组患者24 h尿蛋白定量、血浆白蛋白(ALB)、肌酐(CREA)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血浆纤维蛋白原(FIB)、三酰甘油(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、总胆固醇(TC)的变化。结果 治疗后,对照组和低分子肝素大、中、小剂量组缓解率分别为65.0%、95.0%、85.0%、70.0%,大、中剂量组的缓解率明显高于对照组;大剂量组的缓解率明显高于中、小剂量组,差异有统计学意义(P<0.05)。4组患者24 h尿蛋白定量均较治疗前显著降低,ALB显著升高,同组治疗前后差异有统计学意义(P<0.05);大、中、小剂量组患者CREA均较治疗前显著降低,差异有统计学意义(P<0.05);且大剂量组24 h尿蛋白定量、ALB、CREA的改善程度优于其他3组,差异有统计学意义(P<0.05)。大、中、小剂量组TG、TC、LDL均显著降低,同组治疗前后差异有统计学意义(P<0.05);且大、中、小剂量组的改善程度优于对照组,差异有统计学意义(P<0.05)。低分子肝素大、中、小剂量组PT、APTT均较治疗前明显延长,其中大剂量组高于中、小剂量组(P<0.05);FIB较治疗前明显减少,且大剂量组FIB低于小剂量组(P<0.05)。结论 低分子肝素治疗难治性肾病综合征具有较好的临床疗效,可改善患者的高凝状态,尤其是大剂量组疗效更佳。

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.