目的 探讨尿毒清颗粒联合贝那普利治疗早期糖尿病肾病的临床效果。方法 选取2017年6月—2021年6月天津市第五中心医院收治的300例早期糖尿病肾病患者，运用随机数字表法将300例患者随机分成对照组和治疗组，每组各150例。对照组口服盐酸贝那普利片，10mg/次，1次/d。治疗组在对照组基础上口服尿毒清颗粒（无糖型），每日6∶00、12∶00、18∶00时各服1袋，22∶00时服2袋，温开水冲服。两组均连续治疗12周。观察两组临床疗效，比较治疗前后两组肾功能指标[肌酐（Cr）、尿素氮（BUN）和24h尿蛋白定量（24h UP）]、欧洲五维健康量表（EQ-5D）评分、肾叶间动脉血流动力学参数[收缩期峰值血流速度（V_max）、舒张末期血流速度（V_min）、阻力指数（RI）]及血清基质金属蛋白酶9（MMP-9）、丙二醛（MDA）、转化生长因子β1（TGF-β1）、血管内皮生长因子（VEGF）水平。结果 治疗后，治疗组总有效率是92.7%，显著高于对照组的80.7%（P<0.05）。治疗后，两组血清Cr、BUN水平及24h UP均显著低于治疗前（P<0.05）；且均以治疗组降低更显著（P<0.05）。治疗后，两组EQ-5D指数、EQ-VAS评分均较治疗前显著增加（P<0.05）；且均以治疗组升高更显著（P<0.05）。治疗后，两组肾叶间动脉V_max、V_min均显著增高，肾叶间动脉RI则均显著降低（P<0.05）；且均以治疗组改善更显著（P<0.05）。治疗后，两组血清MMP-9水均显著升高，血清MDA、TGF-β1和VEGF水平均显著降低（P<0.05）；且治疗后，治疗组血清MMP-9水平高于对照组，MDA、TGF-β1和VEGF水平低于对照组（P<0.05）。结论 尿毒清颗粒联合贝那普利治疗早期糖尿病肾病的整体疗效满意，是改善患者肾功能和提高生活质量的安全有效途径，并能进一步升高血中MMP-9水平及下调血中MDA、TGF-β1、VEGF的水平，值得临床推广。

Objective To investigate the clinical effect of Niaoduqing Granules combined with benazepril in treatment of early diabetic nephropathy. Methods A total of 300 patients with early diabetic nephropathy admitted to Tianjin Fifth Central Hospital from June 2017 to June 2021 were selected and randomly divided into control group and treatment group by random number table method, with 150 cases in each group. Patients in the control group were po administered with Benazepril Hydrochloride Tablets, 10 mg/time, once daily. Patients in the treatment group were po administered with Niaoduqing Granules (sugar-free type) on the basis of the control group, took one bag with warm boiling water at 6, 12 and 18 o’clock every day, and two bags at 22 o’clock. Both groups were treated for 12 weeks. The clinical effect of the two groups was observed, the renal function indexes [creatinine (Cr), blood urea nitrogen (BUN) and 24-hour urine protein quantitative (24-hour UP)], European five-dimensional health before and after treatment between the two groups. Scale (EQ-5D) score, renal interlobar artery hemodynamic parameters [peak systolic blood velocity (V_max), end-diastolic blood velocity (V_min), resistance index (RI)] and serum matrix metalloproteinase 9 (MMP-9), malondialdehyde (MDA), transforming growth factor β1 (TGF-β1), vascular endothelial growth factor (VEGF) levels in two groups before and after treatment were compared. Results After treatment, the total effective rate of the treatment group was 92.7%, which was significantly higher than that of the control group (80.7%, P< 0.05). After treatment, the serum levels of Cr, BUN and 24 h UP in the two groups were significantly lower than those before treatment (P< 0.05). And the reduction was more significant in the treatment group (P< 0.05). After treatment, the EQ-5D index and EQ-VAS score of the two groups were significantly increased compared with those before treatment (P< 0.05). The increase was more significant in the treatment group (P< 0.05). After treatment, V_max and V_min of renal interlobar artery were significantly increased, while RI of renal interlobar artery was significantly decreased in both groups (P < 0.05). The improvement was more significant in the treatment group (P < 0.05). After treatment, serum MMP-9 water was significantly increased, while serum MDA, TGF-β1 and VEGF levels were significantly decreased in the two groups (P < 0.05). After treatment, the serum levels of MMP-9 in the treatment group were higher than those in the control group, and the levels of MDA, TGF-β1 and VEGF were lower than those in the control group (P < 0.05). Conclusion Niaoduqing Granules combined with benazepril has a definite clinical effect in treatment of early diabetic nephropathy, can safely and effectively protect the renal function of patients, improve the life quality, and can further increase the level of MMP-9 in blood and down-regulate the level of MDA, TGF-β1 and VEGF, which is worthy of clinical promotion.

R977

天津市第五中心医院院内科研项目（WZX201909）