目的 探究金匮肾气丸与阿魏酸哌嗪联合治疗脾肾阳虚型慢性肾小球肾炎的临床疗效。方法 纳入2022年8月—2024年8月就诊于武汉市中医医院的脾肾阳虚型慢性肾小球肾炎患者121例，随机分为对照组（60例）和治疗组（61例）。对照组口服阿魏酸哌嗪片，50 mg/次，3次/d；治疗组在对照组治疗基础上口服金匮肾气丸，5 g/次，2次/d。两组患者均进行为期12周治疗。观察两组患者临床疗效，比较治疗前后两组患者临床症状改善时间，肾功能指标尿微量白蛋白（U-mAlb）、估算肾小球滤过率（eGFR）和血清胱抑素C（CysC）水平，血清细胞因子血清铁蛋白（SF）、C-反应蛋白（CRP）及超氧化物歧化酶（SOD）水平。结果 干预后，对照组和治疗组总有效率分别为80.00%和95.08%，两组比较差异具有统计学意义（P＜0.05）。干预后，治疗组颜面浮肿、疲倦乏力、频繁夜尿、腰脊酸痛等症状改善时间明显短于对照组（P＜0.05）。干预后，两组患者U-mAlb与CysC均显著降低，而eGFR水平同步升高（P＜0.05），且治疗组的指标改善程度明显优于对照组（P＜0.05）。治疗后，两组血清SF和CRP水平均出现明显下降，同时SOD活性有所提升（P＜0.05），且治疗组的指标改善程度明显优于常规对照组（P＜0.05）。结论 金匮肾气丸联合阿魏酸哌嗪在脾肾阳虚型慢性肾炎治疗中呈现显著协同效应，不仅有效改善患者疲倦乏力、频繁夜尿等临床症状，同时实现肾功能指标和血清标志物的同步改善，为脾肾阳虚型慢性肾小球肾炎的个体化治疗提供了新策略。

Objective To evaluate the clinical efficacy of Jinkui Shenqi Pills combined with piperazine ferulate in treating chronic glomerulonephritis characterized by spleen-kidney yang deficiency. Methods Patients (121 cases) with chronic glomerulonephritis of spleen-kidney yang deficiency in Wuhan Traditional Chinese Medicine Hospital from August 2022 to August 2024 were randomly divided into control (60 cases) and treatment (61 cases) group. Patients in the control group were po administered with Piperazine Ferulate Tablets, 50 mg/time, three times daily. Patients in the treatment group were po administered with Jinkui Shenqi Pills on the basis of the control group, 5 g/time, twice daily. Patients in two groups were treated for 12 weeks. After treatment, the clinical evaluations were evaluated, and the improvement time of clinical symptoms, the levels of renal function indicators U-mAlb, CysC and eGFR, and the levels of serum SF, CRP and SOD in two groups before and after treatment were compared. Results After treatment, the total effective rates in the control group and the treatment group were 80.00% and 95.08%, respectively, and the difference between the two groups was statistically significant (P < 0.05). After treatment, the improvement time of symptoms such as facial edema, fatigue, frequent nocturia and lumbar and spinal pain in the treatment group was significantly shorter than that in the control group (P < 0.05). After treatment, U-mAlb and CysC were significantly reduced in two groups, while eGFR levels were increased simultaneously (P < 0.05), and the improvement of indicators in the treatment group was significantly better than that in the control group (P < 0.05). After treatment, serum SF and CRP levels in two groups were significantly decreased, while SOD activity was increased (P < 0.05), and the improvement of indicators in the treatment group was significantly better than that in the routine control group (P < 0.05). Conclusion The combination of Jinkui Shenqi Pills and piperazine ferulate synergistically enhances therapeutic efficacy in chronic glomerulonephritis patients with spleen-kidney yang deficiency. It not only effectively improves clinical symptoms such as fatigue and frequent nocturia in patients, but also achieves synchronous improvement of renal function indicators and serum markers, providing a new strategy for individualized treatment of chronic glomerulonephritis with spleen kidney yang deficiency.

R983

湖北省中医药管理局中医药科研项目（ZY2023F055）