CAJ | 학술논문

目的：观察前列地尔对 I - II 期特发性膜性肾病的临床与血流变学的作用。方法将36例经肾脏活检诊断为 I - II 期特发性膜性肾病患者随机平均分为两组，即对照组和治疗组，每组18例。两组均常规均给予泼尼松联合环磷酰胺治疗。治疗组在此基础上加用前列地尔治疗。治疗前后检测24 h 尿蛋白定量、血浆白蛋白、血肌酐、内生肌酐清除率以及血液流变学指标结果。结果对照组和治疗组在治疗后24h 尿蛋白定量明显下降，血浆白蛋白显著提高，有统计学意义（P ＜0.05）。血肌酐、内生肌酐清除率无明显变化，无统计学意义（ P ＞0.05）。而治疗后，治疗组的24 h 尿蛋白定量以及血浆白蛋白改善明显优于对照组，有统计学意义（ P ＜0.05）。对照组患者全血黏度（低切、高切）、血浆黏度、纤维蛋白原等血液流变学指标与治疗前比较差异无显著性（ P ＞0.05），而治疗组患者血液流变学指标较治疗前有明显改善（P ＜0.05），同时治疗组与对照组患者治疗后血液流变学指标比较差异有显著性（P ＜0.05）。结论前列地尔不仅能降低 I - II 期特发性膜性肾病患者尿蛋白含量，提升血浆白蛋白水平，而且能改善血流微循环，减少血栓形成的可能，从而能有效延缓肾脏疾病的进展。
목적：관찰전렬지이대 I - II 기특발성막성신병적림상여혈류변학적작용。방법장36례경신장활검진단위 I - II 기특발성막성신병환자수궤평균분위량조，즉대조조화치료조，매조18례。량조균상규균급여발니송연합배린선알치료。치료조재차기출상가용전렬지이치료。치료전후검측24 h 뇨단백정량、혈장백단백、혈기항、내생기항청제솔이급혈액류변학지표결과。결과대조조화치료조재치료후24h 뇨단백정량명현하강，혈장백단백현저제고，유통계학의의（P ＜0.05）。혈기항、내생기항청제솔무명현변화，무통계학의의（ P ＞0.05）。이치료후，치료조적24 h 뇨단백정량이급혈장백단백개선명현우우대조조，유통계학의의（ P ＜0.05）。대조조환자전혈점도（저절、고절）、혈장점도、섬유단백원등혈액류변학지표여치료전비교차이무현저성（ P ＞0.05），이치료조환자혈액류변학지표교치료전유명현개선（P ＜0.05），동시치료조여대조조환자치료후혈액류변학지표비교차이유현저성（P ＜0.05）。결론전렬지이불부능강저 I - II 기특발성막성신병환자뇨단백함량，제승혈장백단백수평，이차능개선혈류미순배，감소혈전형성적가능，종이능유효연완신장질병적진전。
Objective:To observe clinical and blood rheology effect of alprostadil to I - II stage idiopathic membranous nephropathy. Method:36 cases of renal biopsy for the diagnosis of I - II in patients with idiopathic membranous nephropa-thy were randomly divided into two groups,The control group and treatment group,each group consists of 18 cases. The two groups were both given prednisone and cyclophosphamide treatment,the treatment group was combined with alprostadil on the basis of routine treatment. Before and after treatment,24h urinary protein,plasma albumin,serum creatinine,cre-atinine clearance rate and the indexes of blood rheology were observed. Result:After treatment of the control group and the treatment group,24h urinary protein decreased significantly,and plasma albumin was significantly increased,there was sta-tistical significance(P < 0. 05),Serum creatinine,endogenous creatinine clearance rate had no obvious changes,there was no statistical significance(P > 0. 05). After treatment,the 24 h urine protein quantitative,and plasma albumin of the treat-ment group were significantly better than the control group,there was statistical significance(P < 0. 05). After treatment of patients in the control group,the whole blood viscosity,plasma viscosity,fibrinogen and blood rheology indicators were no significant difference compared with before treatment(P > 0. 05),While the blood rheology of the treatment group im-proved significantly compared with before treatment(P < 0. 05). At the same time,the blood rheology of the treatment group had significant difference compared with the control group of patients after treatment(P < 0. 05). Conclusion:Alpros-tadil can not only reduce proteinuria in patients with stage I - II idiopathic membranous nephropathy ,increase the plasma albumin level,but also improve the blood microcirculation,reduce the possibility of thrombosis,which can effectively delay the progression of renal disease.