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目的探讨低分子肝素钙(LMWH-Ca)联合糖皮质激素治疗肾病综合征(NS)的疗效及安全性。方法选取50例NS患者随机分成两组,治疗组和对照组各25例,对照组采用激素疗法并联合降脂、降压和利尿等常规治疗;治疗组在对照组治疗方案的基础上加用LMWH-Ca 4100AXa IU皮下注射,一日2次,用药4周,观察治疗前后血浆白蛋白(ALB)、24 h尿蛋白定量(24hup)、纤维蛋白原(FIB)、总胆固醇(Tch)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、D-二聚体浓度(D-dimer)、血小板计数(PLT)和血肌酐(Scr)。结果治疗后两组ALB均上升,24hup、Tch、D-dimer、PLT值和FIB均下降,与治疗前比较差异显著(P<0.01),且治疗组与对照组相比,ALB值增加更为显著,24hup、Tch、D-dimer、PLT值和FIB值降低更为显著(P<0.01)。治疗组总有效率为89.5%,显著优于对照组的71.7%(P<0.05),治疗组无出血倾向发生。结论 LMWH-Ca与糖皮质激素联合治疗NS具有协同作用,可降低尿蛋白和血脂,改善患者的高凝状态,且安全。
Objective To investigate the efficacy and safety of low molecular weight heparin (LMWH-Ca) combined with glucocorticoid in the treatment of nephrotic syndrome (NS). Methods Fifty patients with NS were randomly divided into two groups. The treatment group and the control group were 25 cases each. The control group was treated with hormone therapy combined with conventional therapy such as lipid-lowering, antihypertensive and diuretic. The treatment group was treated with the control group LMWH-Ca 4100AXa IU was injected subcutaneously twice a day for 4 weeks to observe the changes of ALB, 24hup, FIB, Tch, Partial thromboplastin time (APTT), prothrombin time (PT), D-dimer, platelet count (PLT) and serum creatinine (Scr). Results After treatment, the ALB in both groups increased, the values of 24hup, Tch, D-dimer, PLT and FIB decreased significantly compared with that before treatment (P <0.01), and ALB increased more in the treatment group than in the control group Significantly, 24hup, Tch, D-dimer, PLT values and FIB values decreased more significantly (P <0.01). The total effective rate was 89.5% in the treatment group, which was significantly superior to 71.7% in the control group (P <0.05). No bleeding tendency occurred in the treatment group. Conclusion The combination of LMWH-Ca and glucocorticoids has a synergistic effect on NS, which can reduce urinary protein and lipids, improve the hypercoagulability of patients and is safe.