摘要
目的:观察利伐沙班治疗肾病综合征(NS)伴低抗凝血酶Ⅲ(AT-Ⅲ)血症患者血栓栓塞并发症的临床疗效与安全性。方法:16例经血管超声、肾静脉或肺动脉CT血管造影确诊并发血栓栓塞症的低AT-Ⅲ的NS患者,随机分为利伐沙班组(8例):口服利伐沙班30 mg/d治疗(早20 mg、晚10 mg,间隔12h);低分子肝素组(8例):皮下注射低分子肝素5 000 IU/12h治疗。总疗程4周,在随访基线(入组时)及第2、4周观察记录患者各项临床指标及CT血管造影。主要疗效终点为患者已有血栓消失或血栓体积缩小≥90%。次要指标包括:原有血栓扩大或新发血栓或深静脉血栓脱落致新发肺栓塞;由肺动脉或静脉血栓导致死亡;临床严重出血并发症;治疗过程中血清AT-Ⅲ变化情况。结果:两组各7例患者累积到达疗效终点,其中利伐沙班组第2周达疗效终点者5例,第4周达疗效终点者2例;低分子肝素组则分别为4例和3例。两组均无血栓加重及新发血栓情况发生,无临床严重出血并发症及死亡事件发生。利伐沙班组中所有患者在第2周血清AT-Ⅲ水平升至正常范围。低分子肝素组中6例患者于第2周血清AT-Ⅲ升至正常范围,2例患者于第4周时血清AT-Ⅲ升至正常。结论:利伐沙班与低分子肝素治疗伴低AT-Ⅲ血症的NS并发的血栓栓塞症的患者,疗效及安全性相当,无明显不良反应。
Objective：To evaluate the effect and safety of rivaroxaban in treating thromboembolism with low AT-Ⅲ nephrotic syndrome（NS）. Methodology： A total of sixteen patients with AT-III-deficiency NS were diagnosed, with the complications of thromboembolism by vascular ultrasound, renal venous or pulmonary artery computed tomography angiography（CTA） .They were randomly divided into two groups： rivaroxaban group treated with rivaroxaban 30 mg per day （n=8） and Low Molecular Heparin（LWMH） group injected with LWMH 5 000 IU per 12 hours （n=8）. All clinical data were collected at baseline, the 2nd and 4th week. All patients reexamined CTA at 2nd week, if thrombus didn＇t deflate obviously, the patients would do CTA at 4th week again. The primary curative effect endpoint was thrombus disappearing or volume of thrombus was reduced by 90% or more. Results： In rivaroxaban group, 5 patients and 2 patients reached the primary endpoint at the 2nd and 4th week respectively. In LWMH group, 4 patients and 3 patients reached the primary endpoint at the 2nd and 4th week respectively. But the accumulative total incidence of primary endpoint of the two groups was both 7. There was no severe hemorrhage in two groups. Conclusion：The effect and safety of rivaroxaban in treating thromboembolism with low AT-Ⅲ NS was affirmative.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
北大核心
2015年第1期6-10,共5页
Chinese Journal of Nephrology,Dialysis & Transplantation
基金
国家科技支撑计划课题(2013BAI09B04)
关键词
肾病综合征
血栓
抗凝血酶Ⅲ
利伐沙班
抗凝
nephrotic syndrome thromboembolism AT-Ⅲ rivaroxaban anticoagulation
