目的 探讨达格列净联合阿托伐他汀治疗糖尿病肾病的临床效果。方法 前瞻性选取甘肃省武威市人民医院2019年6月-2020年12月收治的87例糖尿病肾病患者为研究对象，应用随机数字分组法将患者分为对照组与试验组，对照组44例，试验组43例。在常规治疗的基础上，对照组患者口服达格列净片，第1~3天，每天5 mg，第4天增加剂量，每次10 mg。试验组在对照组治疗基础上，同时患者口服阿托伐他汀片，每次20 mg，每天1次。两组患者均进行3个月治疗，对比治疗效果。分别于治疗前后测定两组患者尿白蛋白排泄率（UAER）、血清β2-微球蛋白（β2-MG）和胱抑素C （CysC）水平，应用肌氨酸氧化酶法测定血肌酐水平；观察并记录两组患者治疗前后的餐后2 h血糖、空腹血糖和糖化血红蛋白水平；观察并记录所有患者在治疗中出现的不良反应情况。结果 试验组治疗总有效率93.02%，对照组总有效率81.81%，试验组总有效率显著高于对照组（P<0.05）；治疗前两组患者UAER、β2-MG、CysC和血肌酐水平对比无明显差异（P>0.05），治疗后两组患者UAER、β2-MG、CysC和血肌酐水平均显著降低（P<0.05），且治疗后试验组患者UAER、β2-MG、CysC和血肌酐水平低于对照组（P<0.05）；两组患者治疗前餐后2 h血糖、空腹血糖和糖化血红蛋白水平对比无明显差异（P>0.05），治疗后两组患者餐后2 h血糖、空腹血糖和糖化血红蛋白水平均显著降低（P<0.05），且治疗后试验组患者的餐后2 h血糖、空腹血糖和糖化血红蛋白水平显著低于对照组（P<0.05）；对照组咳嗽1例、头晕1例、恶心1例、头痛2例，不良反应发生率为11.36%，试验组咳嗽1例、头晕2例、恶心1例、头痛1例，不良反应发生率为11.63%，两组对比无明显差异（P>0.05）。结论 糖尿病肾病患者在常规治疗基础上应用阿托伐他汀联合达格列净进行治疗，患者的临床症状明显减轻，患者的肾功能得到改善，治疗效果显著提高；阿托伐他汀联合达格列净能减轻糖尿病肾病患者肾功能损伤和微血管并发症，提升肾小球滤过功能，提高降糖效果，安全性好，值得临床应用推广。

Objective To explore the clinical effect of atorvastatin combined with dagliquin in the treatment of diabetic nephropathy. Methods A total of 87 patients with diabetic nephropathy were selected from June 2019 to December 2020 in Wuwei People's Hospital of Gansu province. The patients were randomly divided into control group and experimental group, 44 cases in the control group and 43 cases in the experimental group. On the basis of routine treatment, patients in the control group were given Dagliquin Tablets orally, five mg per day on the first to third days, and ten mg per time on the fourth day. On the basis of the treatment of the control group, patients in the experimental group were given oral Atorvastatin Tablets, 20 mg each time, once a day. Patients in two groups were treated for three months, and the therapeutic effects were compared. Urinary albumin excretion rate (UAER), serum β2-microglobulin (β2-MG) and cystatin C (CysC) were measured before and after treatment, and serum creatinine was measured by sarcosine oxidase method. The levels of postprandial blood glucose, fasting blood glucose and glycosylated hemoglobin were observed and recorded before and after treatment. The adverse reactions of all patients during treatment were observed and recorded. Results In the experimental group, the total effective rate was 93.02%. In the control group, the total effective rate was 81.81%. Thetotal effective rate in the experimental group was significantly higher than that in the control group (P < 0.05). Before treatment, there was no significant difference in the levels of UAER, β2-MG, CysC and blood creatinine between the two groups (P>0.05). After treatment, the levels of UAER, β2-MG, CysC and serum creatinine in the two groups decreased significantly (P < 0.05), and the levels of β2-MG, CysC and serum creatinine in the experimental group were lower than those in the control group (P < 0.05). There was no significant difference in the levels of postprandial blood glucose, fasting blood glucose and glycosylated hemoglobin between the two groups before treatment (P>0.05). The levels of postprandial blood glucose, fasting blood glucose and glycosylated hemoglobin in the two groups decreased significantly after treatment (P < 0.05). The levels of fasting blood glucose and glycosylated hemoglobin in the experimental group were significantly lower than those in the control group (P < 0.05). There were one case of cough, one case of dizziness, one case of nausea and two cases of headache in the control group, and the adverse reaction rate was 11.36%. There were one case of cough, two cases of dizziness, one case of nausea and one case of headache in the experimental group. The incidence of adverse reactions was 11.63%. There was no significant difference between the two groups (P>0.05). Conclusion Diabetic nephropathy patients treated with atorvastatin combined with dagliquin on the basis of conventional treatment, the clinical symptoms of patients were significantly reduced, the renal function of patients was improved, and the treatment effect was significantly improved. The combination of atorvastatin and dagliquin can reduce the renal damage and microvascular complications in diabetic nephropathy patients, improve glomerular filtration function, improve the effect of lowering blood sugar, and have good safety. It is worthy of clinical application and promotion.

R969.4

武威市市列科技计划项目（WW1902023）