目的 探讨雷公藤多苷片联合非奈利酮治疗2型糖尿病肾病的临床疗效。方法 纳入2023年1月—2025年3月在首都医科大学附属北京友谊医院肾内科门诊规律就诊的2型糖尿病肾病患者108例，按随机数字表法分为对照组和治疗组。对照组口服非奈利酮片，10～20 mg/次，1次/d。治疗组在对照组基础上餐后口服雷公藤多苷片，1 mg/(kg·d)，最大剂量60 mg/d，3次/d。两组治疗12周。对比两组患者治疗前后临床疗效指标，包括尿蛋白、肾功能等实验室指标，中医证候积分、肾脏病生活质量量表1.3（KDQOL-SF 1.3）和症状自评量表（SCL-90）评分，以及血清C1q/肿瘤坏死因子相关蛋白3（CTRP3）、1-磷酸鞘氨醇（S1P）、分泌型卷曲相关蛋白1（SFRP1）、转化生长因子-β1（TGF-β1）水平。结果 治疗后，治疗组总有效率为94.44%，明显高于对照组（81.48%，P＜0.05）。治疗后，两组实验室指标评分24 h UP、UACR及Scr均显著降低，而GFR和Alb显著上升（P＜0.05）；且治疗组患者这些实验室指标明显好于对照组（P＜0.05）。治疗后，两组中医证候积分、SCL-90评分显著降低，而KDQOL-SF 1.3评分显著升高（P＜0.05）；且治疗组评分明显优于对照组（P＜0.05）。治疗后，两组血清CTRP3、S1P水平显著升高，而SFRP1、TGF-β1水平显著下降（P＜0.05）；且治疗组血清CTRP3、S1P、SFRP1和TGF-β1水平明显好于对照组（P＜0.05）。结论 雷公藤多苷片联合非奈利酮治疗2型糖尿病肾病，能有效调节代谢紊乱，抑制患者机体炎症反应及肾组织纤维化，从而减少蛋白尿，保护肾功能，缓解临床症状，利于患者心理状态和生活质量好转。

Objective To explore the clinical efficacy of Tripterygium Glycosides Tablets combined with finerenone in treatment of type 2 diabetic nephropathy. Methods A total of 108 patients with type 2 diabetic nephropathy who received regular follow-up in the Outpatient Department of Nephrology, Beijing Friendship Hospital, Capital Medical University from January 2023 to March 2025 were enrolled and equally divided into the control group and the treatment group according to the random number table method. The control group was orally administered Finerenone Tablets at a dose of 10 — 20 mg per time, once a day. On the basis of the control group, the treatment group was additionally orally administered Tripterygium Glycosides Tablets after meals at a dose of 1 mg/(kg·d), with a maximum dose of 60 mg/d, three times a day. Both groups were treated for 12 weeks. The clinical efficacy indicators before and after treatment were compared between the two groups, including laboratory indicators such as urine protein and renal function, Traditional Chinese Medicine (TCM) syndrome scores, Kidney Disease Quality of Life Short Form 1.3 (KDQOL-SF 1.3) scores, Symptom Checklist 90 (SCL-90) scores, as well as serum levels of C1q/tumor necrosis factor-related protein 3 (CTRP3), sphingosine-1-phosphate (S1P), secreted frizzled-related protein 1 (SFRP1), and transforming growth factor-β1 (TGF-β1). Results After treatment, the total effective rate of the treatment group was 94.44%, which was significantly higher than that of the control group (81.48%, P < 0.05). After treatment, the laboratory indicators including 24-hour urinary protein (24 h UP), urinary albumin-to-creatinine ratio (UACR), and serum creatinine (Scr) in both groups were significantly decreased, while the estimated glomerular filtration rate (GFR) and albumin (Alb) were significantly increased (all P < 0.05); moreover, these laboratory indicators in the treatment group were significantly better than those in the control group (P < 0.05). After treatment, the TCM syndrome scores and SCL-90 scores in both groups were significantly decreased, while the KDQOL-SF 1.3 scores were significantly increased (all P < 0.05); and the scores in the treatment group were significantly superior to those in the control group (P < 0.05). After treatment, the serum levels of CTRP3 and S1P in both groups were significantly increased, while the serum levels of SFRP1 and TGF-β1 were significantly decreased (all P < 0.05); additionally, the serum levels of CTRP3, S1P, SFRP1, and TGF-β1 in the treatment group were significantly better than those in the control group (P < 0.05). Conclusion The combined application of Tripterygium Glycosides Tablets and finerenone in treatment of type 2 diabetic nephropathy can effectively regulate metabolic disorders, inhibit the inflammatory response and renal tissue fibrosis in patients, thereby reducing proteinuria, protecting renal function, relieving clinical symptoms, and facilitating the improvement of patients’ psychological status and quality of life.

R983

北京市通州区科技计划项目（KJ2024CX054）