摘要
目的 探讨不同剂量低分子肝素联用治疗小儿难治性肾病综合征的近远期疗效与安全性.方法 前瞻性选取2021年1月至2024年1月在青海红十字医院诊治的小儿难治性肾病综合征127例作为研究对象.按照随机数字表法将患儿分为小剂量组(n=31)、中剂量组(n=34)、大剂量组(n=34)、对照组(n=28).对照组患儿给予醋酸泼尼松片、环磷酰胺治疗.小剂量组在对照组基础上加用低分子肝素钙注射液,腹壁皮下注射,每次3 075 U,隔日注射1次;中剂量组每天注射1次,大剂量组每天注射2次,共治疗6个月.比较4组患儿近远期疗效,比较4组患儿治疗前、治疗6个月时的肾功能指标(24 h尿蛋白定量、肌酐、血浆白蛋白)、凝血功能指标[活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)]、血脂指标(甘油三酯、高密度脂蛋白、低密度脂蛋白、总胆固醇)水平.观察4组患儿治疗6个月期间不良反应发生情况.结果 4组患儿近期、远期疗效比较,差异均无统计学意义(P＞0.05).治疗6个月时,4组患儿的24 h尿蛋白定量、肌酐水平均较治疗前明显降低,血浆白蛋白水平均较治疗前明显升高,差异均有统计学意义(P＜0.05);小、中、高剂量组的24 h尿蛋白定量、肌酐水平均明显低于对照组,血浆白蛋白水平均明显高于对照组,差异均有统计学意义(P＜0.05).治疗6个月时,4组患儿的APTT均较治疗前明显升高,FIB水平均较治疗前明显降低,差异均有统计学意义(P＜0.05);小、中、高剂量组患儿的APTT均明显高于对照组,FIB水平均明显低于对照组,差异均有统计学意义(P＜0.05).治疗6个月时,4组患儿的甘油三酯、低密度脂蛋白、总胆固醇水平均较治疗前明显降低,差异均有统计学意义(P＜0.05);治疗6个月时,4组患儿高密度脂蛋白水平与治疗前比较,差异均无统计学意义(P＞0.05).小、中、高剂量组患儿的甘油三酯、低密度脂蛋白、总胆固醇水平均明显低于对照组,差异均有统计学意义(P＜0.05),而高密度脂蛋白与对照组比较,差异均无统计学意义(P＞0.05).小、中、高剂量组的肾功能、凝血功能、血脂水平比较,差异均无统计学意义(P＞0.05).小剂量组发生注射部位皮下硬结1例(3.33％),中剂量组发生注射部位皮下硬结3例(10.00％),大剂量组发生注射部位皮下硬结6例(20.00％),对照组发生深静脉血栓3例(10.71％).大剂量组不良反应发生率均较小剂量组、中剂量组、对照组高,但4组组间比较差异无统计学意义(P＞0.05).结论 在醋酸泼尼松、环磷酰胺治疗基础上联用小、中、高剂量低分子肝素后能提高小儿难治性肾病综合征的近远期疗效,显著改善肾功能、凝血功能,调节血脂水平,不同剂量低分子肝素的疗效无显著差异,但小剂量低分子肝素应用较为安全,患儿接受度高.
Abstract
Objective To investigate the short-term and long-term efficacy and safety of different doses of low molecular weight heparin in the treatment of refractory nephrotic syndrome in children.Methods A total of 127 cases of pediatric refractory nephrotic syndrome were se-lected for diagnosis and treatment in Qinghai Red Cross Hospital from January 2021 to January 2024,and were divided into the low-dose group(n=31),the medium-dose group(n=34),the high-dose group(n=34),and the control group(n=28)according to the random number table method.The low-dose group were given low molecular weight heparin calcium injection on the basis of control group,subcutaneous injection in the abdominal wall,3 075 U each time,once every other day.The medium-dose group were injected once a day and the high-dose group were injected twice a day for 6 months.The short-term and long-term efficacy of the four groups were compared.The levels of renal func-tion indexes(24 h urinary protein quantification,creatinine,plasma albumin),coagulation function indexes[activated partial thromboplastin time(APTT),fibrinogen(FIB)]and blood lipid indexes(triglyceride,high density lipoprotein,low density lipoprotein,total cholesterol)were com-pared among the four groups before treatment and 6 months after treatment.The incidence of adverse reactions during 6 months of treatment was ob-served among the four groups.Results There were no statistically significant differences in the short-term and long-term efficacy among the four groups(P＞0.05).After 6 months of treatment,the levels of 24 h urine protein and creatinine in the four groups were significantly lower than those before treatment,and the levels of plasma albumin were significantly higher than those before treatment,the differences were statistically significant(P＜0.05).The levels of 24 h urine protein and creatinine in the low,medium and high dose groups were significantly lower than those in the control group,and the levels of plasma albumin was significantly higher than those in the control group,the differences were statistical-ly significant(P＜0.05).After 6 months of treatment,APTT in the four groups was significantly higher than that before treatment,and FIB level was significantly lower than that before treatment,the differences were statistically significant(P＜0.05).The APTT of children in the low,me-dium and high dose groups was significantly higher than that in the control group,and the FIB level was significantly lower than that in the control group,the differences were statistically significant(P＜0.05).After 6 months of treatment,the levels of triglyceride,low density lipoprotein and total cholesterol in the four groups were significantly lower than those before treatment,and the differences were statistically significant(P＜0.05);after 6 months of treatment,there was no statistically significant difference in the level of high-density lipoprotein between the four groups and be-fore treatment(P＞0.05).The levels of triglyceride,low density lipoprotein and total cholesterol in the low,medium and high dose groups were significantly lower than those in the control group,and the differences were statistically significant(P＜0.05);there was no statistically signifi-cant difference in high density lipoprotein between the two groups(P＞0.05).There were no statistically significant differences in renal function,coagulation function and blood lipid levels among the small,medium and high dose groups(P＞0.05).There were no statistically significant differences in renal function,coagulation function and blood lipid levels among the small,medium and high dose groups(P＞0.05).There were 1 case(3.33％)of subcutaneous induration at the injection site in the low-dose group,3 cases(10.00％)of subcutaneous induration at the in-jection site in the middle-dose group,6 cases(20.00％)of subcutaneous induration at the injection site in the high-dose group,and 3 cases(10.71％)of deep vein thrombosis in the control group.The rate of adverse reactions in the high-dose group was higher than those in the low-dose group,the middle-dose group and the control group,but there was no statistically significant difference among the four groups(P＞0.05).Conclusion On the basis of prednisone acetate and cyclophosphamide treatment,combined with small,medium and high doses of low molecular weight heparin can improve the short-term and long-term efficacy of children with refractory nephrotic syndrome,significantly improve renal function,coagulation function,and regulate blood lipid levels.There is no statistically significant difference in the efficacy of different doses,but low-dose low-molecular-weight heparin is safer and more acceptable to children.
维普
万方数据