目的 探讨非奈利酮联合恩格列净治疗早中期糖尿病肾病的临床疗效。方法 选取2023年1月—2024年2月复旦大学附属中山医院青浦分院收治的68例早中期糖尿病肾病患者，依据随机数字表法分为对照组和治疗组，每组各34例。对照组口服恩格列净片，10 mg/次，1次/d，同时口服厄贝沙坦片，0.15 g/次，1次/d。治疗组口服恩格列净片，10 mg/次，1次/d，同时口服非奈利酮片，10～20 mg/d，持续服用4周后，20 mg/d。两组患者均治疗3个月。观察两组患者临床疗效，比较治疗前后两组患者空腹血糖（FBG）、餐后2 h血糖（2 h PG）、糖化血红蛋白（HbA1c）、降钙素原（PCT）、白细胞计数（WBC）、C反应蛋白（CRP）、白细胞介素-6（IL-6）、24 h尿蛋白定量（24 h UP）、尿微量白蛋白/尿肌酐（ACR）、尿素氮（BUN）、血肌酐（Scr）和估算的肾小球滤过率（eGFR）水平。结果 治疗后，对照组和治疗组患者总有效率分别为76.47%和97.06%，两组比较差异具有统计学意义（P＜0.05）。治疗后，两组患者FBG、2 h PG、HbA1c、PCT、WBC、CRP、IL-6、24 h UP、ACR、BUN和Scr水平比治疗前明显降低，而eGFR水平明显升高（P＜0.05），且治疗组患者这些指标水平较治疗前降低更显著（P＜0.05）。结论 非奈利酮联合恩格列净治疗早中期糖尿病肾病患者的效果更好，能减轻炎症反应，改善肾功能。

Objective To explore the effect of finerenone combined with empagliflozin in treatment of early and middle stage diabetes nephropathy. Methods Patients (68 cases) with early and middle stage diabetes nephropathy in Qingpu Branch, Zhongshan Hospital Affiliated to Fudan University from January 2023 to February 2024 were divided into control and treatment group according to random number table method, and each group had 34 cases. Patients in the control group were po administered with Empagliflozin Tablets, 10 mg/time, once daily, and at the same time they were po administered with Irbesartan Tablets, 0.15 g/time, once daily. Patients in the treatment group were po administered with Empagliflozin Tablets, 10 mg/time, once daily, and at the same time they were po administered with Finerenone Tablets, 10 — 20 mg/d for 4 weeks, then 20 mg/d. Patients in two groups were treated for 3 months. After treatment, the clinical evaluations were evaluated, the levels of FBG, 2 h PG, HbA1c, PCT, WBC, CRP, IL-6, 24 h UP, ACR, BUN and Scr in two groups before and after treatment were compared. Results After treatment, the total clinical effective rates of patients in the control group and treatment group were 76.47% and 97.06%, respectively, and the difference was statistically significant between two groups (P < 0.05). After treatment, the levels of FBG, 2 h PG, HbA1c, PCT, WBC, CRP, IL-6, 24h UP, ACR, BUN, and Scr in two groups were significantly lower than before treatment, while the eGFR level was significantly higher (P < 0.05), and the levels of these indicators in the treatment group decreased more significantly than before treatment (P < 0.05). Conclusion Finerenone combined with empagliflozin has a better effect in treating patients with early and mid-stage diabetic nephropathy, which can reduce inflammatory response and improve renal function.

R977

上海市青浦区卫生健康系统第五轮学科建设和人才培养项目(TX2023-26);青浦区科技发展基金项目(QKY2021-05)