低分子肝素对肾病综合征患者的疗效和安全性

目的 采用多中心、随机、开放的平行对照研究,评价低分子肝素对肾病综合征患者的蛋白尿和肾功能改善的疗效及安全性。方法 上海市7所3级医院确诊的肾病综合征患者118例,随机分为两组：①肾病综合征标准治疗组(常规组,23例)：给予标准剂量的泼尼松;②标准治疗 低分子肝素钙治疗组(低分子肝素钙组,95例)：给予低分子肝素钙(商品名为速碧林,Sanofi公司)0．3～0．6ml／d,每日1次,腹壁皮下注射,每2～4周进行生化等指标评估。两组患者均随访8周。结果治疗后14d低分子肝素钙组患者的24h尿蛋白及血清白蛋白水平均有明显改善,但常规组无明显变化。其他可能的影响因素如血压、年龄、性别、肾功能、血小板及白陶土部分凝血活酶时间(KPTT)均无明显变化。治疗后56d,低分子肝素钙组患者的血尿素氮和血肌酐均明显下降,而常规组无改变。两组患者均未发生大出血、肾静脉血栓形成等严重不良事件。结论低分子肝素作为肾病综合征高凝状态时的对症治疗,对于改善肾功能和蛋白尿具有一定的疗效,且安全、可靠。

Effect and safety of low molecular weight heparin in nephrotic syndrome

Objective To evaluate the role of low molecular weight heparin in nephrotic syndrome. Methods One hundred and eighteen patients with nephrotic syndrome were randomly assigned to a standard therapy group and a standard therapy with low molecular weight heparin group. After entry into the study, assessment of biochemical markers were performed every two or four weeks and both group were followed up to eight weeks. Results After 14 days, the concentrations of urine protein and serum album in were signficantly improved in low molecular weight heparin group, but not in the standard group. Other factors as blood pressure, age, sex, renal function, platelet or KPTT showed no changes in both groups. After 56 days, the serum levels of Cr and BUN were all declined in low molecular weight heparin group. Conclusion As a symptomatic therapy of hypercoagulable state in nephrotic syndrome, low molecular weight heparin can be effective to a certain degree in improving proteinuria and renal function.