低相对分子质量肝素对免疫球蛋白A肾病的疗效观察

目的探讨低相对分子质量肝素(LMWH)对免疫球蛋白A(IgA)肾病的临床疗效。方法 57例IgA肾病患者随机分成两组,即对照组[血管紧张素转化酶抑制剂(ACEI)或血管紧张素受体拮抗剂(ARB)+他汀类药物+口服抗凝剂治疗];观察组(ACEI或ARB+他汀类药物+LMWH治疗)。疗程均为6个月。分别于治疗前、治疗后1、3、6个月,检测24h尿蛋白定量、血肌酐(Scr)、凝血酶原时间(PT)、凝血酶时间(TT)及活化部分凝血活酶时间(APTT)。用酶联免疫吸附试验(ELISA)检测尿转化生长因子-β_1(TGF-β_1)和层粘蛋白(LN)水平。结果与对照组相比,观察组在治疗1、3及6月后24h尿蛋白定量、尿TGF-β_1和LN均明显减少(P0.05);治疗6月后,观察组(亚组)Scr水平较对照组(亚组)明显下降(P0.05)。两组间治疗前后PT、TT及APTT水平均无明显变化(P0.05)。结论联合LMWH治疗可进一步减少IgA肾病患者的蛋白尿,改善肾功能。

Observation on effect of low molecular weight heparin in treating IgA nephropathy

Objective To explore the effect of low molecular weight heparin (LMWH ) in immunoglobulin A nephropathy (IgAN) .Methods Totally 57 patients with IgAN were randomly assigned to two groups :the control group[(treatment with angio‐tensin‐converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) plus statins and oral anticoagulant ];the observa‐tion group(treatment of the same as the control group but instead LMWH for oral anticoagulant ) .All patients were treated for 6 months .24 h urinary protein excretion ,serum creatinine ,prothrombin time(PT ) ,thrombin time(T T ) and activated partial thrombo‐plastin time(APTT) were measured before treatment and at 1 ,3 ,6 months after treatment respectively .The level of urinary trans‐forming growth factor‐β1 (TGF‐β1 ) and laminin(LN) were assayed with the enzyme linked immunosorbent assay (ELISA) .Results Compared with the control group ,24 h urinary protein excretion ,urinary TGF‐β1 and LN levels in the observation group were all decreased at 1 ,3 ,6 months after treatment (P<0 .05) .After 6‐month treatment ,serum Scr level in the observation group(syub‐group) was decreased significantly compared with the control group (subgroup)(P<0 .05) .There were no significant differences in PT ,TT and APTT before and after treatment between the two groups (P>0 .05) .Conclusion The combination therapy with LM‐WH can further decrease proteinuria and ameliorate the renal function of IgAN .