目的 探究雷公藤多苷片联合氯沙坦钾治疗特发性膜性肾病的临床疗效。方法 选取2017年12月—2019年12月在保定市第二中心医院接受治疗的80例特发性膜性肾病患者，随机分为对照组（40例）和治疗组（40例）。对照组口服氯沙坦钾片，50mg/次，1次/d。治疗组在对照组的基础上口服雷公藤多苷片，20mg/次，3次/d。两组患者均治疗12个月。观察两组患者临床疗效，比较治疗前后两组患者外周血Th17/Treg、miR-155水平及24h尿蛋白和血清白蛋白水平。结果 治疗后，与对照组总有效率（52.50%）比较，治疗组明显升高（77.50%，P<0.05）。与治疗前比较，治疗后两组Th17/Treg、miR-155水平均明显降低（P<0.05），且与对照组比较，治疗组明显降低（P<0.05）。治疗后，两组24h尿蛋白水平均明显降低，而血清白蛋白水平均升高（P<0.05），且与对照组比较，治疗组24h尿蛋白、血清白蛋白水平明显好于对照组（P<0.05）。结论 雷公藤多苷片联合氯沙坦钾治疗特发性膜性肾病可能通过降低患者外周血Th17/Treg、miR-155水平发挥控制病情的作用，疗效显著。

Objective To explore the effect of Tripterysium Glycosides Tablets combined with losartan potassium in treatment of idiopathic membranous nephropathy. Methods Patients (80 cases) with idiopathic membranous nephropathy in Baoding Second Central Hospital from December 2017 to December 2019 were randomly divided into control (40 cases) and treatment (40 cases) group. Patients in the control group were po administered with Losartan Potassium Tablets, 50 mg/time, once daily. Patients in the treatment group were po administered with Tripterysium Glycosides Tablets on the basis of the control group, 20 mg/time, three times daily. Patients in two groups were treated for 12 months. After treatment, the clinical evaluation was evaluated, the Th17/Treg and miR-155 levels in peripheral blood, and the 24 h urinary protein and serum albumin levels in two groups before and after treatment were compared. Results After treatment, the clinical effective rate of the treatment group (77.50%) was significantly higher than that of the control group (52.50%, P < 0.05). Compared with those before treatment, the levels of Th17/Treg and miR-155 in two groups were significantly decreased after treatment, and which in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, the level of 24 h urinary protein in two groups was significantly decreased, while the level of serum albumin was significantly increased in two groups (P< 0.05). Compared with the control group, the levels of 24 h urinary protein and serum albumin in the treatment group were significantly better than those in the control group (P < 0.05). Conclusion Tripterysium Glycosides Tablets combined with losartan potassium in treatment of idiopathic membranous nephropathy disease by reducing the levels of Th17/Treg and miR-155 in peripheral blood, with significant effect.

R983

保定市科技计划项目（18ZF109）