低分子肝素对小儿难治性肾病综合征伴高凝状态的疗效  

Effectiveness of low molecular weight heparin in treatment of refractory nephropathy with hypercoagulable state in children

作　　者：朱光华[1] 何威逊[1] 罗运九[1] 任志德[1] 

机构地区：[1]上海市儿童医院肾脏内科,200040

出　　处：《中华儿科杂志》2000年第5期282-284,共3页Chinese Journal of Pediatrics

摘　　要：目的　研究低分子肝素对难治性肾病综合征伴高凝状态的疗效。方法　对 15例难治性肾病综合征合并高凝状态的患儿在激素和免疫抑制剂治疗的同时加用低分子肝素 ,剂量为 6 0～ 10 0抗因子Ⅹa活性单位 / (kg·d) ,观察尿蛋白定量、血清白蛋白和胆固醇的变化 ;另设 15例患儿作为对照组。结果　治疗组 13例血D 二聚体恢复正常 ,而对照组仅 5例恢复正常 ,两组之间差异有非常显著意义 (P <0 .0 1)。治疗前 ,治疗组的尿蛋白定量为 (5 .1± 3.6 )g/ 2 4h ,血清白蛋白为 (13.6± 4.3)g/L ,胆固醇 (10 .6± 2 .9)mmol/L。治疗 4周后 ,三项指标分别为 (2 .2± 1.6 )g/ 2 4h、(2 5 .5± 6 .4)g/L和 (8.2± 1.7)mmol/L。治疗组血清白蛋白回升快于对照组 ,两组相比差异有显著意义 (P <0 .0 5 ) ;治疗 8周后 ,三项指标分别为 (0 .8± 0 .8)g/ 2 4h、(32 .7± 3.9)g/L和 (6 .9± 0 .9)mmol/L。三项指标的恢复均优于对照组 ,两组相比差异有显著意义 (P <0 .0 1)。结论　加用低分子肝素治疗难治性肾病综合征合并高凝状态可使尿蛋白、血胆固醇降低 ,血清白蛋白升高。且临床应用方便 。Objective To evaluate the effectiveness of low molecular weight heparin in treatment of refractory nephropathy with hypercoagulable state. Methods Fifteen children with refractory nephropathy who had hypercoagulable state were treated with corticosteroid and an immunosupressive agent plus low molecular weight heparin at the dosage of 60～100AⅩaIU/(kg·d); they were followed up for urine protein quantitation, serum albumin and cholesterol. Another 15 cases with similar conditions were used as control group. The control cases were treated with dipyridamole in addition to corticosteroid and the immunosupressive agent. Results Blood D dimer became negative after treatment in 13 cases of the treatment group but in only 5 cases of the control group ( P <0.01). The urine protein, serum albumin and cholesterol in treatment group were (5.1±3.6) g/24h, (13.6±4.3) g/L and (10.6±2.9) mmol/L, respectively, before treatment and (2.2±1.6)g/24 h, (25.5±6.4) g/L and (8.2±1.7) mmol/L after 4 weeks treatment and (0.8±0.8) g/24h, (32.7±3.9) g/L and (6.9±0.9) mmol/L, respectively, after 8 weeks treatment. These results showed that remarkable improvement was achieved in the treatment group in all the 3 parameters ( P <0.01). Conclusion These results suggest that supplement of low molecular weight heparin in treatment of difficult to manage nephropathy with hypercoagulable state could reduce urine protein and serum cholesterol and increase serum albumin level. The treatment with low molecular weight heparin was safe, effective and convenient.

关 键 词：肾病综合征 高凝状态 低分子肝素 儿童 

分 类 号：R726.9[医药卫生—儿科]