ISSN 1674-3865  CN 21-1569/R
主管：国家卫生健康委员会
主办：中国医师协会
　　　辽宁省基础医学研究所
　　　辽宁中医药大学附属医院
中国中西医结合儿科学

中国中西医结合儿科学 ›› 2018, Vol. 10 ›› Issue (3): 222-226.doi: 10.3969/j.issn.1674-3865.2018.03.012

• 临床研究 • 上一篇    下一篇

不同剂量低分子肝素对过敏性紫癜性肾炎患儿血清胱抑素C、基质金属蛋白酶9与β2微球蛋白水平及凝血功能的影响

孙燕，任耀全，李冬梅，刘晓春，李莉，肖亚洲   

  1. 745100 甘肃 庆阳，甘肃省庆城县人民医院儿科（孙燕，刘晓春，李莉，肖亚洲）；730050 兰州，甘肃省中医院儿内科（任耀全，李冬梅）
  • 出版日期:2018-06-25 发布日期:2018-11-19
  • 通讯作者: 孙燕，E-mail：994978901@qq.com
  • 作者简介:孙燕（1971-），女，副主任医师。研究方向：小儿内科疾病的诊治

Effect of low molecular weight heparin in different doses on the levels of serum CysC, MMP-9 and β2-MG and the coagulation function in children with Henoch Schonlein purpura nephritis

SUN Yan，REN Yaoquan，LI Dongmei，LIU Xiaochun，LI Li，XIAO Yazhou   

  1. Department of Paediatrics, People's Hospital of Qingcheng County，Qingyang 745100，China
  • Online:2018-06-25 Published:2018-11-19

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摘要：
目的
探讨不同剂量低分子肝素对过敏性紫癜性肾炎患儿血清胱抑素C(CysC)、基质金属蛋白酶9（MMP-9）与β2微球蛋白(β2-MG)水平及凝血功能的影响。
方法
选择2015年11月至2017年4月甘肃省庆城县人民医院儿科收治住院的过敏性紫癜性肾炎患儿94例作为研究对象，随机分为小剂量低分子肝素组和大剂量低分子肝素组各47例。两组均给予基础治疗，在此基础上小剂量低分子肝素组皮下注射50～100 U/(kg·d)低分子肝素钙治疗，大剂量低分子肝素组皮下注射150 U/(kg·d)低分子肝素钙治疗。比较两组患儿临床疗效、血清CysC、MMP-9、β2-MG水平、炎性因子水平、凝血指标及不良反应发生情况。
结果
（1）小剂量低分子肝素组临床总有效率为91.5%（43/47）与对照组的93.6%（44/47）比较差异无统计学意义(P>0.05)。（2）两组患儿治疗后血清CysC、MMP9、β2MG水平均显著低于同组治疗前，差异有统计学意义(P<0.05)；两组治疗后血清CysC、MMP-9、β2-MG水平比较差异无统计学意义(P>0.05）。（3）两组患儿治疗后IL-4、IL-6及IL-8水平均显著低于同组治疗前，差异有统计学意义(P<0.05)，两组治疗后各炎性指标水平比较差异无统计学意义(P>0.05)。（4）两组患儿治疗后凝血活酶时间、纤维蛋白原及D二聚体检测值均显著低于同组治疗前，差异有统计学意义(P<0.05)，凝血酶原时间检测值显著高于同组治疗前，差异有统计学意义(P<0.05)。治疗后两组各凝血指标检测值比较差异无统计学意义(P>0.05)。（5）小剂量低分子肝素组不良反应发生率为25.5%（12/47），显著低于大剂量低分子肝素组4.3%（2/47），差异有统计学意义（P<0.05）。
结论
过敏性紫癜性肾炎患儿临床使用不同剂量低分子肝素治疗均可取得理想的临床疗效，皮下注射小剂量低分子肝素安全性更高。

关键词: 过敏性紫癜性肾炎, 低分子肝素, 炎性因子, 凝血功能, 不良反应, 儿童

Abstract:
Objective
To explore the effect of low molecular weight heparin in different doses on the levels of serum CysC, MMP-9 and β2-MG and the coagulation function in children with Henoch Schonlein purpura nephritis.
Methods
Totally 94 children with Henoch Schonlein purpura nephritis treated in our hospital from November 2015 to April 2017 were selected, and were divided into group A (small dose) and group B(large dose) randomly, 47 cases in each group. Both groups were given basic treatment, and on the basis of that, group A were given subcutaneous injection of 50～100 U/(kg·d) low molecular heparin calcium, and group B were given subcutaneous injection of 150 U/(kg·d) low molecular heparin calcium. Clinical efficacy, the levels of serum CysC, MMP-9 and β2-MG, inflammatory factors, blood coagulation indexes and adverse reactions were compared between the two groups.
Results
Total effective rate of group A was 93.62%(43/47), and there was no significant difference when compared with that of control group(95.74%,44/47)(P>0.05). Serum CysC, MMP-9, and β2-MG levels were significantly lower than those before treatment in the two groups(P<0.05), but there was no significant difference between the two groups(P>0.05). IL-4, IL-6 and IL-8 levels were significantly lower than those before treatment in the two groups(P<0.05), with little difference between the two groups(P>0.05). APTT, Fig and D-D levels were significantly lower than those before treatment in the two groups(P>0.05), and PT level was significantly higher than that before treatment, but there was no significant difference between the two groups(P>0.05). The incidence of adverse reactions in group A (25.5%,12/47) was significantly lower than that in group B (4.3%,2/47)(P<0.05).
Conclusion
Satisfactory results can be achieved in treatment of children with Henoch Schonlein purpura nephritis with different doses of low molecular weight heparin, and subcutaneous injection of low molecular weight heparin is of higher safety.

Key words: Henoch Schonlein purpura nephritis, Low molecular weight heparin, Inflammatory factors, Coagulation function/Adverse reaction, Child