目的 探讨非奈利酮联合厄贝沙坦治疗糖尿病肾脏病的临床疗效。方法 选取2021年6月—2023年8月驻马店市中心医院收治的150例糖尿病肾病患者，依据用药差异情况分为对照组和治疗组，每组各75例。对照组患者口服厄贝沙坦片，150 mg/次，1次/d。在对照组的基础上，治疗组患者口服非奈利酮片，20 mg/次，1次/d。两组均用药30 d。观察两组患者的临床疗效，比较治疗前后两组患者临床症状改善情况，血清肌酐（SCr）、血尿素氮（BUN）、血清糖原合酶激酶-3β（GSK-3β）、分泌型卷曲蛋白-4（SFRP-4）、转化生长因子-β1（TGF-β1）、细胞间黏附分子-1（ICAM-1）水平。结果 治疗后，对照组和治疗组临床总有效率分别为86.67%、96.00%，两组比较差异具有统计学意义（P＜0.05）。治疗后，治疗组的肢体水肿、蛋白尿、乏力、面色苍白等症状好转时间均短于对照组（P＜0.05）。治疗后，两组肾功能指标SCr、BUN和血清TGF-β1、SFRP-4、GSK-3β、ICAM-1水平均明显降低（P＜0.05），且治疗后治疗组SCr、BUN、TGF-β1、SFRP-4、GSK-3β、ICAM-1水平均明显低于对照组（P＜0.05）。结论 非奈利酮联合厄贝沙坦治疗糖尿病肾脏病对糖尿病肾病患者临床症状有效改善，并能缓解肾功能状态，促进机体炎性反应减弱。

Objective To explore the clinical effects of finerenone combined with irbesartan in treatment of diabetes nephropathy. Methods Patients (150 cases) with diabetes nephropathy in Zhumadian Central Hospital from June 2021 to August 2023 were selected and were divided into control and treatment group based on different treatments. Each group had 75 cases. Patients in the control group were po administered with Irbesartan Tablets, 150 mg/time, once daily. Patients in the treatment group were po administered with Finerenone Tablets on the basis of the control group, 20 mg/time, once daily. Patients in two groups were treated for 30 d. After treatment, the clinical evaluations were evaluated, the improvement of clinical symptoms, serum creatinine (SCr), blood urea nitrogen (BUN), and serum glycogen synthase kinase-3β (GSK-3β), secretory curly protein-4 (SFRP-4) and transforming growth factor-β1 (TGF-β1) and intercellular adhesion molecule (ICAM-1) in two groups before and after treatment were compared. Results After treatment, the clinical effective rates in the control group and the treatment group were 86.67% and 96.00% respectively, and the difference between two groups was statistically significant (P < 0.05). After treatment, the improvement time of clinical symptoms such as limb edema, proteinuria, fatigue and pale complexion was shorter than that in the control group (P < 0.05). After treatment, the levels of renal function indexes SCr and BUN and serum TGF-β1, SFRP-4, GSK-3β and ICAM-1 in two groups were significantly decreased (P < 0.05), and the SCr, BUN, TGF-β1, SFRP-4, GSK-3β and ICAM-1 in the treatment group was significantly lower than those in the control group (P < 0.05). Conclusion Finerenone combined with irbesartan in treatment of diabetes nephropathy can effectively improve the clinical symptoms of patients with diabetes nephropathy, can also alleviate renal function and promote the weakening of inflammatory response.

R983

河南省医学科技攻关计划项目（LHGJ20210413）