摘要
目的探讨低分子肝素钙/磺达肝癸钠序贯联合双嘧达莫预防性抗凝在原发性肾病综合征(PNS)中的应用效果及安全性。方法回顾性选取2020年3月至2022年12月期间四川省凉山彝族自治州第一人民医院收治的188例PNS患者,根据肾穿刺活检病理结果及磷脂酶A2受体抗体分为膜性肾病组(n=73)与非膜性肾病组(n=115)。两组患者均根据血清白蛋白水平,采用低分子肝素钙或磺达肝癸钠序贯联合双嘧达莫抗凝。比较两组患者治疗前及治疗后4周、治疗后6个月的肾功能指标[白蛋白、尿素氮、血肌酐、肾小球滤过率(eGFR)和24 h尿蛋白定量(24 h PRO)],治疗前及治疗后4周的血栓弹力图指标[反应指数(R时间)、凝血时间(K时间)、血栓最大弹力度(MA)、凝血指数(CI)和α角],以及随访6个月记录血栓事件、出血事件。结果治疗后4周、6个月,两组的白蛋白、eGFR均较治疗前明显升高,尿素氮、血肌酐、24 h PRO均较治疗前明显降低,差异均有统计学意义(P<0.05),但两组治疗后各肾功能指标比较,差异均无统计学意义(P>0.05)。治疗后4周,两组患者的R时间、K时间均较治疗前明显延长,MA、CI值和α角均较治疗前明显降低,差异均有统计学意义(P<0.05),但两组患者治疗后4周的R时间、K时间、MA、CI值和α角比较,差异均无统计学意义(P>0.05)。膜性肾病组患者的血栓、出血事件发生率分别为6.85%、10.96%,均高于非膜性肾病组(0.87%、3.48%),但两组间血栓事件总发生率、出血事件发生率比较,差异均无统计学意义(P>0.05)。结论低分子肝素钙/磺达肝癸钠序贯联合双嘧达莫预防性抗凝有利于改善PNS患者的肾功能,缓解高凝状态,降低血栓栓塞事件发生率,且非膜性肾病患者获益较膜性肾病患者更明显,安全性更高。
Objective To explore the efficacy and safety of low molecular weight heparin calcium/fondaparinux sodium sequential dipyridamole preventive anticoagulation in patients with primary nephrotic syndrome(PNS).Methods Retrospectively 188 patients with PNS admitted to the First People's Hospital of Liangshan Yi Autonomous Prefecture,Sichuan Province from March 2020 to December 2022,were divided into membranous nephropathy group(n=73)and the non-membranous nephropathy group(n=115)according to the pathological results of renal puncture biopsy and phospholipase A2 receptor antibody.In two groups,anticoagulation with LMWH calcium or sulfa was sequential combined with dipyridamole according to serum albumin level.The renal function index[albumin,urea nitrogen,blood creatinine,glomerular filtration rate(eGFR),and 24-hour urine protein quantification(24 h PRO)]before treatment,4 weeks and 6 months after treatment,monitor thromboelastography index[response index(R time),coagulation time(K time),maximum strength(MA),coagulation index(CI)andαangel]before treatment and 4 weeks after treatment were compared,and thrombotic events and bleeding events at 6 months of follow-up were recorded.Results At 4 weeks and 6 months after treatment,albumin and eGFR in two groups were significantly higher than those before treatment,while urea nitrogen,serum creatinine and 24 h PRO were significantly lower than those before treatment,the differences were statistically significant(P<0.05),however,there were no statistically significant differences in renal function indicators between the two groups after treatment(P>0.05).At 4 weeks after treatment,the R time and K time of two groups were longer than those before treatment,and the MA,CI values,andαangel were lower than those before treatment,the differences were statistically significant(P<0.05),however,there were no statistically significant differences in the R time,K time,MA,CI values,andαangel between the two groups at 4 weeks after treatment(P>0.05).The incidence of thrombosis(6.85%)and bleeding events(10.96%)in patients with membranous nephropathy were significantly higher than those in patients with non-membranous nephropathy(0.87%and 3.48%),but there were no statistical differences between the two groups(P>0.05).Conclusion Low molecular weight calcium/fondaparinux sodium sequential dipyridamole preventive anticoagulation is beneficial to improve the renal function of PNS patients,alleviate hypercoagulability,reduce the incidence of thromboembolic events,and patients with nonmembranous nephropathy benefit more significantly than patients with membranous nephropathy.
作者
鄢成静
孙艳
冷彦飞
周芸
袁飞远
YAN Cheng-jing;SUN Yan;LENG Yan-fei(Department of Nephrology,The First People's Hospital of Liangshan Yi Autonomous Prefecture,Liangshan Sichuan 615000,China;Department of General Practice,Luji Township Health Center,Xide County,Liangshan Yi Autonomous Prefecture,Liangshan Sichuan 616750,China)
出处
《临床和实验医学杂志》
2024年第6期577-581,共5页
Journal of Clinical and Experimental Medicine
基金
四川省医学会专项科研课题(编号:2019HR70)。
关键词
肾病综合征
膜性肾病
非膜性肾病
低分子肝素钙
磺达肝癸钠
双嘧达莫
预防性抗凝
Nephrotic syndrome
Membranous nephropathy
Nonmembranous nephropathy
Low molecular weight heparin calcium
Fondaparinux sodium
Dipyridamole
Preventive anticoagulation
