低分子肝素治疗儿童原发性肾病综合征疗效观察

目的研究低分子肝素治疗小儿原发性肾病综合征的疗效及安全性。方法确诊的56例患儿随机分成对照组和治疗组各28例。在抗感染、降压、利尿等治疗基础上,对照组给予泼尼松2 mg.kg-1.d-1(最大剂量≤60 mg.d-1),4 wk获完全缓解者改为间歇疗法,总疗程8～12 wk;治疗组给予低分子肝素0.01 mg.kg-1.d-1,腹壁皮下注射每日1次,疗程4 wk。观察治疗前后血浆蛋白定量、24 h尿蛋白定量、肝功能、肾功能及不良反应。结果 2组患者治疗后各指标与治疗前相比均有非常显著差异(P<0.01);2组间白蛋白、24 h尿蛋白量的变化均有非常显著差异(P<0.01)。治疗组完全缓解10例,基本缓解4例,部分缓解11例,总有效率89%;对照组完全缓解5例,基本缓解2例,部分缓解11例,总有效率64%。2组疗效有显著差异(P<0.05)。治疗过程中2组肝、肾功能无异常;对照组出现皮疹1例,治疗组未发现不良反应。结论低分子肝素治疗小儿原发性肾病综合征疗效显著,不良反应少。

Clinical observation of low-molecular-weight heparin in treatment of primary nephrotic syndrome in children

AIM To study the effect and safety of low-molecular-weight heparin in treatment of primary nephrotic syndrome in children.METHODS Total 56 diagnosed children with primary nephrotic syndrome were randomly divided into treatment group and control group(n = 28 for each).The two groups were both treated with anti-infection,lowering blood pressure and diuresis.Besides,the control group was given prednisone 2 mg·kg-1·d-1(maximum dose ≤ 60 mg·d-1).If children get complete remission after 4 week-treatmnet,the control group was given 8-12 weeks intermittent therapy.The treatment group was treated with abdominal subcutaneous injection of low-molecular-weight heparin 0.01 mg·kg-1·d-1 daily for 4 weeks.The plasma proteins,24-h urine protein,liver function and kidney function of the two groups before and after the treatment were measured,and the adverse reactions were observed.RESULTS There were significant differences(P < 0.01)between pretherapy and post-treatment in total plasma proteins,albumin,and 24-h urine protein of the two groups.After the treatment,there were significant differences(P < 0.01)in the changes of plasma albumin and 24-h urine protein between the two groups.In the treatment group,there were 10 cases with complete remission,4 cases with basic remission and 11 cases with partial remission,and the total effective rate was 89%;in the control group,there were 5 cases with complete remission,2 cases with basic remission and 11 cases with partial remission,and the total effective rate was 64%.The curative effects of the two groups were significantly different(P < 0.05).There was no abnormity of live or kidney occurred in the two groups,and there was one case of tetter in the control group and no adverse reactions in the treatment group.CONCLUSION Low-molecular-weight heparin has significant treatment effect in treating primary nephrotic syndrome of children,and with no obvious adverse reactions.