目的 分析玉屏风颗粒联合泼尼松和环孢素治疗特发性膜性肾病的临床疗效。方法 选取河池市中医医院在2020年3月—2022年7月收治的90例特发性膜性肾病患者，随机分为对照组和治疗组，每组各45例。对照组口服醋酸泼尼松片，起始剂量为1 mg/(kg∙d)，共服用4周，此后每周减量10 mg维持；同时口服环孢素胶囊，剂量为3～5 mg/(kg∙d)，1次/12 h。治疗组在对照组方案基础上口服玉屏风颗粒，5 g/次，3次/d。两组患者治疗3个月。观察两组患者临床疗效，比较治疗前后两组患者中医证候积分，肾功能指标24 h尿蛋白定量（24 h UP）、血尿素氮（BUN）、血清肌酐（Scr）和血清白蛋白（Alb），及Th17/Treg免疫平衡指标。结果 治疗后，治疗组临床有效率为（91.11%）明显高于对照组（73.33%，P＜0.05）。治疗后，两组患者中医症候积分均有降低（P＜0.05）；治疗组主要中医证候积分均明显低于对照组（P＜0.05）。治疗后，两组患者24 h UP、BUN、Scr、Th17、Th17/Treg明显低于治疗前，而Alb和Treg高于治疗前（P＜0.05），且治疗组肾功能指标和免疫指标明显好于对照组（P＜0.05）。结论 玉屏风颗粒联合泼尼松和环孢素治疗特发性膜性肾病临床疗效显著，可改善患者主要中医症候和肾功能指标，调节Th17/Treg免疫平衡态，治疗安全性较好。

Objective To analyze the clinical efficacy of Yupingfeng Granules combined with prednisone and cyclosporine in treatment of idiopathic membranous nephropathy. Methods Patients (90 cases) with idiopathic membranous nephropathy in Hechi Traditional Chinese Medicine Hospital from March 2020 to July 2022 were randomly divided into control and treatment group, and each group had 45 cases. Patients in the control group were po administered with Prednisone Acetate Tablets, the initial dose was 1 mg/(kg·d) for 4 weeks, followed by a reduction of 10 mg per week, while Cyclosporine Capsules were taken orally at a dose of 3-5 mg/(kg·d), once per 12 h. Patients in the treatment group were po administered with Yupingfeng Granules on the basis of the control group, 5 g/time, three times daily. Patients in two groups were treated for 3 months. After treatment, the clinical evaluation was evaluated, and the TCM symptom scores, renal function indexes 24 h UP, BUN, Scr and Alb, and Th17/Treg immune balance indexes in two groups before and after treatment were compared. Results After treatment, the clinical effective rate of the treatment group (91.11%) was significantly higher than that of the control group (73.33%, P < 0.05). After treatment, TCM symptom scores were decreased in both groups (P < 0.05), and the scores of main TCM symptoms in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, 24 h UP, BUN, Scr, Th17 and Th17/Treg in two groups were significantly lower than those before treatment, while Alb and Treg were higher, and the renal function and immune indexes in the treatment group were significantly better than those in the control group (P < 0.05). Conclusion Yupingfeng Granules combined with prednisone and cyclosporine is effective in the treatment of idiopathic membranous nephropathy, which can improve the main TCM symptoms and renal function indexes, regulate the immune balance of Th17/Treg, and the treatment is safe.

R983

广西壮族自治区中医药管理局自筹经费科研项目（GZZC2020335）