目的 探讨益肾化湿颗粒联合坎地沙坦酯治疗糖尿病肾病的有效性与安全性。方法 选取2016年1月—2017年1月在山东中医药大学第二附属医院治疗的糖尿病肾病患者145例，根据用药方案的不同分成对照组（72例）和治疗组（73例）。对照组患者口服坎地沙坦酯片，2片/次，1次/d；治疗组在对照组的基础上口服益肾化湿颗粒，1袋/次，3次/d。所有患者均治疗1个月。观察两组患者临床疗效，比较治疗前后两组患者炎症因子水平、糖化血红蛋白（HbA1c）、内脂素水平、24 h尿蛋白定量、血肌酐、尿素氮和不良反应情况。结果 治疗后，对照组和治疗组临床总有效率分别为84.72%和97.26%，两组比较差异具有统计学意义（P<0.05）。治疗后，两组患者肿瘤坏死因子-α和白细胞介素-6水平显著降低（P<0.05）；且治疗组患者上述炎症因子水平降低更明显（P<0.05）。治疗后，两组患者HbA1c和内脂素水平显著降低（P<0.05）；且治疗组患者HbA1c和内脂素水平明显低于对照组（P<0.05）。治疗后，两组患者24 h尿蛋白定量、血肌酐和尿素氮水平均显著均下降（P<0.05）；且治疗组患者上述各指标明显低于对照组（P<0.05）。治疗期间，治疗组患者不良反应发生率为2.74%，明显低于对照组的13.89%，两组患者比较差异具有统计学意义（P<0.05）。结论 益肾化湿颗粒联合坎地沙坦酯治疗糖尿病肾病具有疗效好、安全性高的特点，具有一定的临床推广应用价值。

Objective To explore the efficacy and safety of Yishen Huashi Granules combined with candesartan in treatment of diabetic nephropathy. Methods Patients (145 cases) with diabetic nephropathy in the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 2016 to January 2017 were divided into control (72 cases) and treatment (73 cases) according to different treatment. Patients in the control group were po administered with Candesartan Cilexetil Tablets, 2 tablets/time, once daily. Patients in the treatment group were po administered with Yishen Huashi Granules on the basis of the control group, 1 bag/time, three times daily. Patients in two groups were treated for 1 month. After treatment, the clinical efficacy was evaluated, and the levels of inflammatory factors, HbA1c, Visfatin, 24 h urine protein quantitative, serum creatinine and urea nitrogen, and the adverse reactions in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 84.72% and 97.26% respectively, and there were differences between two groups (P < 0.05). After treatment, the tumor necrosis factor-α and IL-6 levels in two groups were significantly decreased (P < 0.05). And these inflammatory factors levels in the treatment group after treatment were significantly lower than those in the control group (P < 0.05). After treatment, the HbA1c and visfatin levels in two groups were significantly decreased (P < 0.05). And the HbA1c and visfatin levels in the treatment group after treatment were significantly lower than those in the control group (P < 0.05). After treatment, the 24 h urine protein quantitative, serum creatinine and urea nitrogen levels in two groups were significantly decreased (P < 0.05). And these indicators level in the treatment group after treatment was significantly lower than that in the control group (P < 0.05). During the treatment, the incidence of adverse reactions in the treatment group was 2.74%, which was significantly lower than 13.89% in the control group, with significant difference between two groups (P < 0.05). Conclusion Yishen Huashi Granules combined with candesartan has good curative effect and high safety in treatment of diabetic nephropathy, which has a certain clinical application value.