| Objective:The clinical efficacy and safety of beraprost sodium(BPS)combined with glucocorticoid(GC)and/or immunosuppressives were evaluated in the treatment of patients with primary nephrotic syndrome(PNS).Methods:Retrospective study was conducted in Department of Nephrology of China-Japan Union Hospital,Jilin University.Eighty-six patients diagnosed with PNS were selected from September 2014 to March 2016 and were divided into BPS group(n=42)and control group(n=44).Patients in BPS group received GC and/or immunosuppressives combined with BPS,while the patients in control group were treated with GC and/or immunosuppressives combined with aspirin or dipyridamole.The baseline clinical data and laboratory index of the two groups were collected and compared.All the patients were followed up on the time of 1,2,3,6 and 12 months after treatment.The differences of therapeutic response,laboratory indices and the incidence of complication or adverse drug reaction between two groups were compared.The data was analyzed with SPSS 17.0 statistical software and P<0.05 was considered statistically significant.Results:1.Comparison of therapeutic response at the 6th month between two groups.The total remission rates in BPS group and in control group after treatment of 6 months were 92.86% and 72.73% respectively and the partial remission rates were 7.14% and27.27% respectively.Both of the difference were significant between two groups(P<0.05).2.Comparison of the urinary protein excretion and serum biochemical indices after treatment between two groups.The urinary protein excretion at the 1st,2nd,3rd,6th and 12 th month after treatment in BPS group were significantly lower than that before treatment(P<0.05 and P<0.01 respectively).The urinary protein excretion at the 2nd,3rd,6th and 12 th month after treatment in control group were significantly lower than that before treatment(P<0.05 and P<0.01 respectively).Compared with control group,the urinary protein excretion at 1st or 6th month after treatment were significantly lower in BPS group at the corresponding follow-up time respectively(P<0.05).The serum albumin at the 1st,2nd,3rd,6th and 12 th month after treatment in BPS group were significantly higher than that before treatment(P<0.05 and P<0.01 respectively).The serum albumin at the 2nd,3rd,6th and 12 th month after treatment in control group were significantly higher than that before treatment(P<0.05 and P<0.01 respectively).Compared with control group,the serum albumin at the 1st and 6th month after treatment were significantly higher in BPS group at the corresponding follow-up time respectively(P<0.05).The serum creatinine at the 3rd,6th and 12 th month after treatment in BPS group were significantly decreased compared with that before treatment respectively(P<0.05).The serum creatinine at the 6th and 12 th month after treatment in control group were significantly decreased compared with that before treatment respectively(P<0.05).The level of total cholesterol and triglycerides in two groups were significantly decreased at the 1st,2nd,3rd,6th and 12 th month after treatment compared with that before treatment respectively(P<0.01 or P<0.05).Compared with control group,the level of total cholesterol at the 6th month after treatment were significantly lower in BPS group(P<0.05).The level of fibrinogen and D-dimer at the 3rd and 6th month after treatment in BPS group were significantly decreased than that before treatment respectively(P<0.05).3.Comparison of coagulation indices between the groups.Compared with control group,the level of fibrinogen and D-dimer in BPS group at the 3rd and 6th month after treatment were significantly lower(P<0.05).The level of fibrinogen and D-dimer at the 12 th month after treatment in BPS group was significantly decreased than that before treatment respectively(P<0.01).The level of fibrinogen and D-dimer at the 6th and 12 th month after treatment in control group was significantly decreased than that before treatment respectively(P<0.05).4.Comparison of blood pressure between the two groups.The systolic and diastolic blood pressure at the 1st and 2nd month after treatment in BPS group dropped significantly compared with that before treatment respectively(P<0.05).Compared with control group,the systolic and diastolic blood pressure at the 1st month aftertreatment were significantly lower in BPS group(P<0.05).5.Comparison of complications and adverse drug reactions between the two groups.The incidence of headache and dizziness in BPS group were 6 cases(14.29%),which were significantly higher than that in control group(P<0.05).The incidence of elevating blood pressure in normal blood pressure patients of control group were 4 cases(9.09%),which were significantly higher than that in BPS group(P<0.05).The patients in two groups presented no bleeding disease,myocardial infarction,interstitial pneumonia or other serious adverse reactions during the course of treatment.Conclusions:1.Combination of BPS with GC and/or immunosuppressives can significantly reduce urinary protein excretion,increase serum albumin level and improve the renal function in patients with PNS.The total remission rate can be improved significantly compared with the combination of GC and/or immunosuppressives with traditional antiplatelet agents.2.BPS combined with GC and/or immunosuppressives can significantly reduce fibrinogen,D-dimer and cholesterol level,thus improve the hypercoagulable state of PNS patients and is superior to traditional antiplatelet agents.3.BPS combined with antihypertensive therapy can ameliorate hypertension earlier in PNS patients treated with GC and/or immunosuppressives and may eliminate the influence of GC on blood pressure of PNS patients to a certain degree,which is superior to traditional antiplatelet agents.4.Although the incidence of headache and dizziness in BPS group was more than that in control group,the other adverse reactions were mild and no severe adverse reaction such as bleeding incidence was observed.Therefore the safety of BPS treatment for PNS patients is relatively high. |
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