目的 探讨天芪降糖胶囊联合氯沙坦治疗早期糖尿病肾病的临床效果。方法 选取2016年5月-2017年4月上海市浦东新区花木社区卫生服务中心收治的早期糖尿病肾病患者72例，随机分成对照组（36例）和治疗组（36例）。对照组口服氯沙坦钾片，100 mg/次，1次/d。治疗组在对照组基础上口服天芪降糖胶囊，1.6 g/次，3次/d。两组均连续治疗12周。观察两组患者临床疗效，比较治疗前后两组患者血清糖化血红蛋白（HbA1c）、血肌酐（Scr）、24 h尿微量白蛋白（24 h UMA）、尿素氮（BUN）、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、足细胞标志蛋白（PCX）、胰岛素抵抗指数（HOMA-IR）、中性粒细胞/淋巴细胞比值（NLR）、肿瘤坏死因子（TNF）-α、IL-6、谷胱甘肽过氧化物酶（GSH-Px）和丙二醛（MDA）水平。结果 治疗后，对照组和治疗组临床总有效率分别为72.2%和91.7%。两组比较差异有统计学意义（P<0.05）。治疗后，两组患者24 h UMA值、血清HbA1c、SCr、BUN、NGAL、PCX、HOMA-IR和外周血NLR水平均显著降低（P<0.01）；且治疗组比对照组更低（P<0.01）。治疗后，两组血清TNF-α、IL-6、MDA浓度较治疗前均显著减少，GSH-Px水平显著升高，同组比较差异具有统计学意义（P<0.05）；且治疗组上述指标显著优于对照组（P<0.05）。结论 应用天芪降糖胶囊联合氯沙坦治疗早期糖尿病肾病可有效提高患者胰岛素敏感性，减轻炎性损伤，调控氧化应激状态，保护肾脏功能。

Objective To investigate the clinical effect of Tianqi Jiangtang Capsules combined with losartan in treatment of early diabetic nephropathy. Methods Patients (72 cases) with early diabetic nephropathy in Huamu Community Health Service Center, Pudong New Area from May 2016 to April 2017 were randomly divided into control (36 cases) and treatment (36 cases). Patients in the control group were po administered with Losartan Potassium Tablets, 100 mg/time, once daily. Patients in the treatment group were po administered with Tianqi Jiangtang Capsules on the basis of the control group, 1.6 g/time, three times daily. Patients in two groups were treated for 12 weeks. After treatment, the clinical efficacy was evaluated, and the HbA1c, Scr, 24 h UMA, BUN, NGAL, PCX, HOMA-IR, NLR, TNF-α, IL-6, GSH-Px and MDA levels in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 72.2% and 91.7%, respectively, and there were differences between two groups (P < 0.05). After treatment, 24 h UMA, HbA1c, SCr, BUN, NGAL, PCX, HOMA-IR and NLR levels in two groups were significantly decreased (P < 0.01), and these indexes levels in the treatment group were significantly lower than those in the control group (P < 0.01). After treatment, TNF-α, IL-6 and MDA in two groups were significantly decreased, but GSH-Px was significantly increased, and the difference was statistically significant in the same group (P < 0.05), and these indexes levels in the treatment group were significantly better than those in the control group (P < 0.05). Conclusion Tianqi Jiangtang Capsules combined with losartan in treatment of early diabetic nephropathy can effectively improve insulin sensitivity, reduce inflammatory injury, regulate oxidative stress and protect renal function.

浦东新区卫生系统优秀青年医学人才培养实施计划项目