预防性抗凝治疗在特发性膜性肾病中的疗效分析  

Efficacy Analysis of Prophylactic Anticoagulation Therapy in Idiopathic Membranous Nephropathy

作　　者：刘子康 梁伟[1] 丁国华[1] LIU Zikang;LIANG Wei;DING Guohua(Department of Nephrology,Renmin Hospital of Wuhan University,Hubei 430060,China)

机构地区：[1]武汉大学人民医院肾内科,430060

出　　处：《医学研究杂志》2023年第8期39-44,54,共7页Journal of Medical Research

基　　金：国家自然科学基金资助项目(82070713)。

摘　　要：目的探讨预防性抗凝治疗在特发性膜性肾病(idiopathic membranous nephropathy,IMN)患者中的疗效及安全性。方法回顾性收集2019年12月~2021年12月在武汉大学人民医院就诊且病理确诊的197例IMN患者的临床资料,根据是否进行预防性抗凝治疗分为预防性抗凝组(n=99)与未预防性抗凝组(n=98),根据抗凝方案差异,预防性抗凝组分为低分子肝素组、低分子肝素+直接口服抗凝剂(direct oral anticoagulants,DOACs)组及华法林组。比较组间实验室检查及病理资料的差异,以及使用抗凝药物6个月后,组间患者的疗效、血栓及出血事件的差异。结果与未预防性抗凝组比较,预防性抗凝组男性比例、年龄、24h尿总蛋白、D-二聚体、血总胆固醇较高,白蛋白(albumin,ALB)、凝血酶Ⅲ活性较低(P<0.05)。两组患者在肾脏病理方面比较,差异无统计学意义。未预防性抗凝组患者的血栓事件比例高于预防性抗凝组(12.2%vs 3.0%,P=0.030),血栓部位以下肢静脉血栓为主;预防性抗凝组出血事件比例高于未预防性抗凝组(15.1%vs 2.0%,P=0.003),出血部位以皮肤黏膜及牙龈出血为主。血栓高风险组(ALB<25g/L)中,未预防性抗凝组血栓事件比例高于预防性抗凝组(9.2%vs 1.0%,P=0.022)。3组比较,华法林组出血比例高于低分子肝素组和低分子肝素+DOACs组(33.3%vs 5.7%vs 16.3%,P=0.042)。结论无论何种预防性抗凝治疗方案(低分子肝素、华法林或DOACs)均可以安全有效地降低IMN患者发生血栓事件风险。Objective To investigate the efficacy and safety of prophylactic anticoagulation therapy in patients with idiopathic membranous nephropathy(IMN).Methods The clinical data of 197 IMN patients with pathologically confirmed diagnosis from December 2019 to December 2021 at the Renmin Hospital of Wuhan University were retrospectively collected.According to whether prophylactic anticoagulation therapy was administered,patients were divided into prophylactic anticoagulation group(n=99)and non-prophylactic anticoagulation group(n=98).According to the anticoagulation protocol,the prophylactic anticoagulation groups were divided into low molecular heparin group,low molecular heparin+DOACs group,and warfarin group.The differences of laboratory examination and pathological data between the groups were compared,and the differences of efficacy,thrombotic and bleeding events between the two groups after using anticoagulants for 6months were compared.Results Compared with the non-prophylactic anticoagulation group,the proportion of female,age,24h total urine protein,D-dimer and total blood cholesterol were higher in the prophylactic anticoagulation group,and the levels of albumin and thrombin II activity were lower than those in the nonprophylactic anticoagulation group(P<0.05).The difference in renal pathology between the two groups was not statistically significant(P>0.05).The proportion of thrombotic events were higher in the non-prophylactic anticoagulation group than those in the prophylactic anticoagulation group(12.2%vs 3.0%,P=0.030),and the site of thrombosis was predominantly lower limb venous thrombosis.The proportion of bleeding events were higher in the prophylactic anticoagulation group than those in the non-prophylactic anticoagulation group(15.1%vs 2.0%,P=0.003),and the site of bleeding was predominantly skin mucosal and gingival bleeding.In the high-risk group for thrombosis(ALB<25g/L),the proportion of thrombotic events were higher in the non-prophylactic anticoagulation group than those in the prophylactic anti

关 键 词：特发性膜性肾病 预防性抗凝治疗 出血 血栓 肾病综合征 

分 类 号：R593.9[医药卫生—内科学]