目的 探讨低分子肝素钙联合他克莫司治疗膜性肾病的临床效果。方法 选取2016年1月—2018年6月陕西省人民医院收治的膜性肾病患者94例，随机分成对照组（47例）和治疗组（47例）。对照组餐前1 h口服他克莫司胶囊，0.05 mg/（kg·d），2次/d。治疗组在对照组基础上腹壁皮下注射低分子肝素钙注射液，5000 AXa单位/次，1次/d。两组均连续治疗4周。观察两组患者临床疗效，同时比较治疗前后两组患者24 h尿蛋白定量（24 h-UTP）、肌酐（Cr）、白蛋白（ALB）、总胆固醇（TC）、三酰甘油（TG）及凝血纤溶指标及炎性因子水平。结果 治疗后，对照组和治疗组的总有效率分别为78.7%和93.6%，两组比较差异具有统计学意义（P<0.05）。治疗后，两组24 h-UTP及血清Cr、TC、TG水平较治疗前均显著降低（P<0.05），血清ALB浓度均显著升高（P<0.05），且治疗后治疗组24 h-UTP、Cr、ALB、TC、TG水平明显优于对照组（P<0.05）。治疗后，两组患者血浆纤维蛋白原（FIB）、血管性血友病因子（vWF）水平及血清D-二聚体（D-D）、白介素-4（IL-4）、IL-10水平均显著下降（P<0.05），且治疗组上述凝血纤溶指标和炎性因子明显低于对照组（P<0.05）。结论 低分子肝素钙联合他克莫司治疗膜性肾病可明显减轻患者症状，改善凝血纤溶状态，抑制炎症反应，保护肾功能。

Objective To investigate the clinical effect of low molecular weight heparin calcium combined with tacrolimus in treatment of membranous nephropathy. Methods Patients (94 cases) with membranous nephropathy in Shaanxi Provincial People's Hospital from January 2016 to June 2018 were randomly divided into control (47 cases) and treatment (47 cases) groups. Patients in the control group were po administered with Tacrolimus Capsules 1 h before meals, 0.05 mg/(kg·d), twice daily. Patients in the treatment group were abdominal subcutaneous injection administered with Low Molecular Weight Heparin Calcium Injection on the basis of the control group, 5 000 AXa/time, once daily. Patients in two groups were treated for 4 weeks. After treatment, the clinical efficacy was evaluated, and the levels of 24 h-UTP, Cr ALB, TC, TG, the coagulation-fibrinolysis indexes, and inflammatory factors in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment groups was 78.7% and 93.6% respectively, and there were differences between two groups (P<0.05). After treatment, the 24 h-UTP, Cr, TC, and TG levels in two groups were significantly decreased (P<0.05), but the serum ALB concentration in two groups was significantly increased (P<0.05), and these indexes levels in the treatment group were significantly better than those in the control group (P<0.05). After treatment, the levels of FIB and vWF in plasma, the levels of D-D, IL-4, IL-10 in serum in two groups were significantly decreased (P<0.05), and the coagulation-fibrinolysis indexes and inflammatory factors levels in the treatment group were significantly lower than those in the control group (P<0.05). Conclusion Low molecular weight heparin calcium combined with tacrolimus in treatment of membranous nephropathy can obviously relieve the symptoms, improve the coagulation and fibrinolysis status, and inhibit inflammatory reaction and protect renal function.