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目的 探讨儿童难治性肾病合并高凝状态患儿的有效治疗措施 ,总结使用低分子量肝素 (LMWH)治疗 36例难治性肾病的经验。方法 在基本治疗的同时加用LMWH 1 0 0～ 1 2 0AXaIU·kg-1·d-1,2周为一疗程。每周监测出凝血时间、凝血酶原时间。 36例中 32例经肾组织活检 ,病理类型分别为 :微小病变 (MCNS) 5例、系膜增生 (MsPGN) 1 7例、膜增殖 (MPGN) 6例、局灶硬化 (FS GS) 4例。结果 经LMWH治疗 2周后 ,不同病理类型肾病对应用LMWH的总有效率达 87 5 % ,其中以MCNS和MsPGN者疗效最好 ,FSGS疗效较差。LMWH治疗前后血液全血粘度低、中、高切变率 ,全血还原粘度低、中、高切变率 ,血浆粘度和红细胞聚集指数均有明显改善 ,36例使用LMWH的难治性肾病患儿均有皮下淤血 ,1例出现血尿。结论 LMWH可降低难治性肾病的高凝状态 ,减轻蛋白尿 ,减少或减轻血栓等并发症的形成 ,宜尽早使用 ,以利于疾病的恢复。
Objective To investigate the effective treatment of children with refractory nephropathy complicated with hypercoagulable state and to summarize the experience of treating 36 cases of refractory nephropathy with low molecular weight heparin (LMWH). Methods The basic treatment plus LMWH 100 ~ 120AXaIU · kg-1 · d-1, 2 weeks for a course of treatment. Clot weekly monitoring of clotting time, prothrombin time. Of 36 cases, 32 cases were examined by renal biopsy. The pathological types were as follows: 5 cases of MCNS, 17 cases of mesangial proliferation (MsPGN), 6 cases of membrane proliferation (MPGN), 4 cases of focal sclerosis (FS GS) . Results After 2 weeks of treatment with LMWH, the total effective rate of LMWH was 87.5% for different pathological types of nephropathy. Among them, MCNS and MsPGN were the best and FSGS were less effective. LMWH blood viscosity before and after low viscosity, medium and high shear rate, whole blood reduced viscosity, medium and high shear rate, plasma viscosity and erythrocyte aggregation index were significantly improved, 36 patients with LMWH refractory nephropathy Children have subcutaneous congestion, hematuria occurred in 1 case. Conclusion LMWH can reduce hypercoagulable state of refractory nephropathy, reduce proteinuria, reduce or reduce the formation of thrombosis and other complications, should be used as soon as possible in order to facilitate the recovery of the disease.