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目的 观察低分子肝素对难治性肾病综合征伴高凝状态的疗效。方法 35例难治性肾病综合征患者 ,随机分为两组 ,对照组用强的松、洛汀新潘生丁、雷公藤多甙、环磷酰胺以及利尿、对症等治疗 ;治疗组在对照组治疗基础上 ,加用低分子肝素 5 0 0 0 IU皮下注射 1次 /日 ,疗程 2个月。结果 治疗 8周后治疗组 FXa明显降低 ,与对照组比较差异显著 (P<0 .0 5 ) ;治疗组尿蛋白明显减少 ,血清 TP、AL B明显升高 ,其中尿蛋白、AL B的变化与对照组比较差异显著 (P<0 .0 5 ) ;血清 TG、 TCHO、 HDL、 L DL均有不同程度的下降 ,其中 TG、 TCHO与对照组比较差异显著 (P<0 .0 5 ) ;血清 BU N、Cr变化差异无显著性 (P>0 .0 5 )。治疗组 11例出现皮下瘀斑 ,未见其它副作用。治疗 1年后治疗组有效率、复发率明显低于对照组 (P<0 .0 5 )。结论 本研究提示 L MWH配合 CTX及适量激素治疗可使难治性肾病综合征患者的高凝状态缓解、尿蛋白减少、血清 TP、 AL B上升 ,从而使病情缓解 ,而且副作用较少
Objective To observe the effect of low molecular weight heparin on refractory nephrotic syndrome with hypercoagulable state. Methods Thirty-five patients with refractory nephrotic syndrome were randomly divided into two groups. Patients in the control group were treated with prednisone, lovastatin dipyridamole, tripterygium wilfordii, cyclophosphamide, diuretic and symptomatic treatment. The treatment group in the control group Based on the addition of low molecular weight heparin 500 IU subcutaneous injection 1 / day, course of treatment for 2 months. Results After treatment for 8 weeks, the FXa in the treatment group was significantly lower than that in the control group (P <0.05); the proteinuria in the treatment group was significantly decreased, the levels of serum TP and AL B were significantly increased, and the changes of urinary protein and AL B TG, TCHO, HDL and DLD all decreased to different extents, among which, TG and TCHO were significantly different from the control group (P <0.05); There was no significant difference in serum BU N, Cr (P> 0.05). Subcutaneous ecchymosis was observed in 11 cases in the treatment group, with no other side effects. After 1 year of treatment, the effective rate and recurrence rate of the treatment group was significantly lower than that of the control group (P <0.05). Conclusions This study suggests that L MWH combined with CTX and appropriate hormones can alleviate the hypercoagulable state, decrease urinary protein and increase serum TP and AL B levels in patients with refractory nephrotic syndrome, thus leading to less remission and fewer side effects