小剂量肝素钙治疗小儿原发性肾病综合征疗效评价

Therapeutic Effect of Low Dose Hepacarin in the Childhood Primary Nephrotic Syndrome

摘要:

目的 探讨小剂量肝素钙在小儿原发性肾病综合征中的治疗作用。方法：对82例原发性肾病综合征合并高凝状态的患儿进行前瞻性研究，所有患儿均常规服用泼尼松每日2 mg/kg (最大量<60 mg/d)，其中52例患儿为肝素钙治疗组(每日50 IU/kg，静脉点滴4周)，另外30例为对照组。结果：治疗组尿蛋白转阴率与对照组差异无显著性(P>0.05)。尿蛋白转阴病例中，治疗组尿蛋白转阴时间明显短于对照组［(13.08±4.75) d vs (19.33±4.48) d］(P<0.01)，开始利尿时间亦明显少于对照组［(9.64±2.65) d vs (17.07±3.99) d］(P<0.01)。治疗组血纤维蛋白原恢复正常率明显高于对照组(93.3% vs 65.4%)(P<0.05)。治疗组尿FDP恢复正常率与对照组差异无显著性(P>0.05)。结论：小剂量肝素钙不能提高原发性肾病综合征患儿尿蛋白转阴率，但可缩短诱导缓解时间，增强利尿效果，且小剂量肝素钙抗凝作用明显。

Abstract:

OBJECTIVE: To investigate the effect of low-dose hepacarin in the treatment of the primary nephrotic syndrome in children. METHODS: Eighty two children with the primary nephrotic syndrome in the hypercoagulable state were studied prospectively. All the patients were administrated with prednisone 2 mg/kg·d (maximum dose ≤ 60 mg/d). Fifty two of them, besides prednisone, were administrated with hepacarin (50 IU/kg·d, intravenous injection for 4 weeks), who formed the treatment group. The other 30 belonged to the control group. RESULTS: There was no significant difference in remission (negative proteinuria) between the treatment group and the control group (P> 0.05 ). The time taken for remission was shorter in the treatment group [( 13.08 ± 4.75 ) d] than that in the control group [( 19.33 ± 4.48 ) d] (P< 0.01 ), so was the initial diuresis time [( 9.64 ± 2.65 ) d vs ( 17.07 ± 3.99 ) d](P< 0.01 ). The plasma fibrinogen recovery efficiency in the treatment group ( 93.3% ) was significantly higher than that in the control group ( 65.4% ) (P< 0.05 ). However, no significant difference in the urinary FDP recovery efficiency was found between the two groups. CONCLUSIONS: Low dose hepacarin had an obvious anticoagulation effect. Although it can not improve the remission rate of urinary protein in the treatment of the primary nephrotic syndrome in children, it can shorten the induced remission time and enhance diuresis effects.