目的 探讨生脉注射液联合泼尼松和环磷酰胺治疗膜性肾病的临床疗效。方法 选择2017年6月-2020年6月上海市第六人民医院金山分院收治的53例膜性肾病的患者，随机分为对照组（25例）和治疗组（28例）。对照组口服泼尼松片，1 mg/kg，1次/d，8周后每2周减量5 mg，减至30 mg/d，再每2周减量2.5 mg，减至20 mg/d；再每4周减2.5 mg，至10 mg/d维持；并静脉滴注注射用环磷酰胺，首月每半月600 mg加入生理盐水100 mL，然后每月800 mg加入100 mL生理盐水，1次/月，共6个月。治疗组在对照组治疗的基础上静脉滴注生脉注射液，40 mL加入250 mL生理盐水，1次/d，治疗14 d停药16 d为1个疗程，共6个疗程。观察两组患者临床疗效，比较治疗前后两组患者24 h尿蛋白定量（24 h Upro）、C反应蛋白（CRP）、降钙素原（PCT）水平。结果 治疗后，治疗组总有效率为78.57%，显著高于对照组64.00%（P<0.05）。治疗3个月和6个月后，两组患者24 h Upro水平显著降低，但PCT、CRP升高（P<0.05），且治疗组治疗后24 h Upro、PCT、CRP水平低于对照组同期（P<0.05）。结论 生脉注射液联合糖皮质激素及环磷酰胺治疗膜性肾病可以提高临床疗效，降低炎症反应的程度。

Objective To investigate the effect of Shengmai Injection combined with prednisone and cyclophosphamide in treatment of membranous nephropathy. Methods Patients (53 cases) with membranous nephropathy in Jinshan Branch of Shanghai the 6th People's Hospital from June 2017 to June 2020 were randomly divided into control (25 cases) and treatment (28 cases) groups. Patients in the control group were po administered with Prednisone Tablets, 1 mg/kg, once daily, reduced 5 mg every 2 weeks to 30 mg/d after 8 weeks, then reduced 2.5 mg every 2 weeks to 20 mg/d, and then reduced 2.5 mg every 4 weeks to 10 mg/d and maintained. At the same time, the control group iv administered with Cyclophosphamide for injection, 600 mg added into 100 mL normal saline in the first month, and then 800 mg added into 100 mL normal saline every month, once monthly, they were treated for 6 months. Patients in the treatment group were iv administered with Shengmai Injection, 40 mL added into 250 mL normal saline, once daily, 14 days of treatment and 16 days of withdrawal was a course of treatment for a total of 6 courses. After treatment, the clinical efficacy was evaluated, the levels of 24 h Upro, PCT and CRP in two groups before and after treatment were compared. Results After treatment, the clinical effective rate in the treatment group was 78.57%, which was significantly higher than 64.00% of the control group (P<0.05). After 3 and 6 months of treatment, the 24 h Upro level in two groups was significantly decreased, but PCT and CRP were increased (P<0.05). The 24 h Upro, PCT and CRP levels in the treatment group were lower than those in the control group (P<0.05). Conclusion Shengmai Injection combined with glucocorticoid and cyclophosphamide can improve the clinical curative effect and reduce the degree of inflammatory reaction.

R983

周锦明全国基层名老中医药专家传承工作室建设项目；上海市金山区卫生和计划生育委员会项目（JSZY201806）