目的 探讨大黄䗪虫丸联合他克莫司胶囊治疗肾病综合征的临床疗效。方法 选取2018年5月-2020年3月在天津中医药大学第一附属医院就诊的92例肾病综合征患者，按照随机数字表法将92例患者分为治疗组和对照组，每组各有46例。对照组口服他克莫司胶囊，0.05 mg/（kg·d），2次/d。治疗组在对照组治疗的基础上口服大黄䗪虫丸，6 g/次，2次/d。两组治疗8周。比较两组的总有效率及24 h尿蛋白定量转阴时间、浮肿消失时间、尿量恢复时间，检测两组患者治疗前后血液流变学指标（血浆黏度、D-二聚体、纤维蛋白原）和肾功能指标[血清白蛋白、24 h尿蛋白定量、肌酐（Scr）]水平。结果 治疗后，治疗组患者的总有效率（93.48%）高于对照组（78.26%），差异有统计学意义（P<0.05）。治疗后，治疗组的24 h尿蛋白定量转阴时间、浮肿消失时间、尿量恢复时间均低于对照组，差异有统计学意义（P<0.05）。治疗后，两组血浆黏度、D-二聚体、纤维蛋白原水平均显著低于治疗前（P<0.05）；治疗后，治疗组的血浆黏度、D-二聚体、纤维蛋白原水平比对照组低（P<0.05）。治疗后，两组血清白蛋白水平显著升高，24 h尿蛋白定量、Scr水平显著降低（P<0.05）；治疗后，治疗组的血清白蛋白水平比对照组高，24 h尿蛋白定量、Scr水平比对照组低（P<0.05）。结论 大黄䗪虫丸联合他克莫司胶囊治疗肾病综合征的临床疗效明确，可促进症状的恢复，改善血液流变学和肾功能，具有良好临床使用价值。

Objective To explore the clinical effect of Dahuang Zhechong Pills combined with Tacrolimus Capsules in treatment of nephrotic syndrome. Methods Patients (92 cases) with nephrotic syndrome in the First Teaching Hospital of Tianjin University of TCM from May 2018 to March 2020 were randomly divided into control and treatment groups, and each group had 46 cases. Patients in the control group were po administered with Tacrolimus Capsules, 0.05 mg/(kg·d), twice daily. Patients in the treatment group were po administered with Dahuang Zhechong Pills on the basis of the control group, 6 g/time, twice daily. Patients in two groups were treated for 8 weeks. After treatment, the clinical efficacies were evaluated, and 24 h urine protein quantitation negative time, edema disappearance time and urine volume recovery in two groups were compared. The hemorheology indexes (plasma viscosity, D-dimer, fibrinogen) and renal function indexes (albumin, urinary protein, Scr) were measured before and after treatment. Results After treatment, the total effective rate of the treatment group (93.48%) was higher than that of the control group (78.26%), and the difference was statistically significant (P<0.05). After treatment, 24 h urine protein quantitation negative time, edema disappearance time and urine volume recovery in the treatment group were shorter than those in the control group, and the difference was statistically significant (P<0.05). After treatment, the plasma viscosity, D-dimer and fibrinogen in the two groups were significantly lower than those before treatment (P<0.05). After treatment, the plasma viscosity, D-dimer and fibrinogen of the treatment group were lower than those of the control group (P<0.05). After treatment, the serum levels of albumin in two groups were significantly increased, but the levels of urinary protein and Scr in two groups were significantly decreased (P<0.05). After treatment, the serum levels of albumin in the treatment group was higher than that of the control group, and the levels of the urine protein and Scr in the treatment group were lower than that of the control group, the difference was statistically significant (P<0.05). Conclusion Dahuang Zhezhong Pills combined with Tacrolimus Capsules has clinical curative effect in treatment of nephrotic syndrome, can promote the recovery of symptoms, improve hemorheology and renal function, which has a good clinical value.

R983

国家自然科学基金资助项目（81373609）