The Effect Of Low-molecular-weight Heparin Calcium On Platelet Parameters And Lipid In Adult Primary Nephrotic Syndrome Patients

Primary nephrotic syndrome mainly manifested substantial proteinuria, hypop- roteinemia, hyperlipidemia and severe edema, PNS is now recognized hyperco- agulable state exists and it is often complicated by a variety of deep vein thrombosis, with the glucocorticoid and the use of strong diuretics, such complic- ations is obviously increased. Patients with primary nephrotic syndrome and systemic exist (or) partial kidney hyperco- agulable state, and kidney have localized platelet, prothrombin activat- ion, fibrin deposition associated antigen and (or) microthr- ombosis, and through a variety of mechanisms lead to glomerular mesangial cells and endothelial cell injury, and proteinuria and renal dysfunction is closely related to. Immune inflammatory response caused by the basement membrane filtration mem- brane damage and the reduction of negative charge and disappear, so that increased permeability and protein leakage, urinary protein loss also promote and increase the coagulation disorder and a vicious circle. Especially when there is hyperlipidemia, the blood viscosity, and further promote intrarenal coagulation and increase the glomerular injury. Not only increased the difficulty of treatment, but severe cases can be life-threatening. Therefore anticoagulation therapy is causing growing attention. Available previously in the low molecular weight heparin, heparin is the main drug selection. However, because of its use is not convenient, easy bleeding, such as disadvantage, constraints in the widely used clinically. Until the emergence of low molecular weight heparin only promoted the further development of anticoagulant therapy.LMWH is by chemical or enzymatic depolymerization of heparin poly- generated fragment, the size of unfractionated heparin equivalent to about 1 / 3, average molecular weight less than 4000 ~ 6500u, low molecular weight heparin has obvious anti-â…©a factor activity, and inhibit thrombin-induced platelet activity is relatively weak, low molecular weight heparin because of the long half-life, bioavailability, so only use one time a day. To low-molecular-weight heparin in the treatment of nephrotic syndrome, the prevention of thrombo-embolism occurred in the role has long been confirmed; With a wide range of clinical applications, other than the low molecular weight heparin anticoagulant role more and more attention.Objective:To observe the adult primary nephrotic syndrome in the conventional treatment based on the use of low-molecular-weight heparin treatment of such patients to explore their blood lipids and platelet parameters.Methods:64 cases of normal renal function of adult primary nephrotic syndrome patients, In the basis of immunosuppressive therapy is divided into plus (treatment group n = 33) and without treatment with low molecular weight heparin calcium (control group n = 31) groups, compared between the two groups beforeand and the level of edema 4 weeks after treatment, 24-hour urinary protein, plasma total protein, albumin, blood triglyceride, total cholesterol, high density lipoprotein cholesterol, low-density lipoprotein cholesterol, apolipoprotein A1, apolipoprotein B, platelet parameters (Plt, MPV , PDW), and treatment before and after the changes in indicators of coagulation (PT, APTT, TT, Fib). And to observe the adverse drug reaction and medication compliance.Results:The treatment group compared with the control group, the level of baseline information (including gender, age, duration, etc.) the same two groups the difference was not significant. And Before treatment two groups of patients ,the 24 hours urinary protein, plasma total protein, albumin, blood triglyceride, total choles- terol, high density lipoprotein cholesterol, low-density lipoprotein cholesterol, apolipoprotein A1, apolipoprotein B, platelet parameters (Plt, MPV, PDW), coagul- ation (PT, APTT, TT, Fib), all information between the two groups there was no significant difference. Medication four weeks after the two groups of patients with edema were significantly ease the difference between the two groups was not significant. 24 hours after treatment were reduced urinary protein, Between the two groups compared Treatment group decreased more obviously, 4 weekend, two groups of patients with plasma albumin and total protein were increased, Between the two groups compared the treatment group increased more significantly, There was a significant difference (p<0.05). 4 weekend, two groups of patients with the treatment of blood triglyceride, total cholesterol, low-density lipoprotein cholesterol, apolipoprotein B was significantly lower than those in the two groups to compare the treatment group decreased more significantly, the difference was statistically significant (p<0.05). Platelet parameters of comparison, two groups of patients after treatment than before the platelet count decreased, but the difference between the two groups was not significant (p<0.05). The two groups before and after treatment and the indicators are in the normal range. Two groups of patients after treatment MPV, PDW were lower than before, but still in the normal range. the indicators of the treatment group decreased more obvious (p<0.05). Coagulation indicators showed: PT, APTT, TT indicators after treatment than those in the above-mentioned two groups before treatment extended, but still in the normal range, inter-group comparison treatment group was more obvious, the difference was significant (p<0.05). Fib of the two groups of patients after treatment decreased, not in excess of the normal range, inter-group comparison showed more pronounced decline in the treatment group, there were significant differences (p<0.05).Conclusion:Low-molecular-weight heparin on edema in patients with PNS worked more pronounced role in the mitigation. Low-molecular-weight heparin was more effective in reducing urinary protein in patients with PNS, and promoted increasing blood TP and ALB. Low-molecular-weight heparin contributed to lower TG, TCH, LDL-C and ApoB in patients with PNS, helped increasing HDL-C, had no effect on ApoA1. Application of low molecular weight heparin calcium in the treatment of PNS , the MPV and PDW decreased more significantly, there was no obviously change on platelet count. Using low-molecular-weight heparin calcium, it did not increase the risk of bleeding, and there were less side effects.