目的 探讨基于“肾痿”理论芪羽水陆地黄汤治疗早期糖尿病肾病（diabetic nephropathy，DN）的临床疗效及对血清足细胞标志蛋白（podocalyxin，PCX）、足细胞裂孔膜蛋白nephrin水平，肾脏血管超声的影响。方法 选取陕西中医药大学附属医院内分泌一科128例III期DN患者，按照随机数字表法分为对照组（64例）及治疗组（64例）。对照组给予常规治疗，治疗组在对照组基础上给予芪羽水陆地黄汤，治疗持续3个月。检测并比较各组治疗前后尿白蛋白排泄率（urinary albumin excretion rate，UAER）、尿白蛋白肌酐比值（urinary albumin creatinine ratio，UACR）水平，血脂、空腹血糖（fasting plasma glucose，FPG）、餐后2 h血糖（2-hour postprandial glucose，2hPG）、糖化血红蛋白（glycated hemoglobin，HbA1C）水平及血清PCX）、nephrin水平及肾脏血管超声变化。评估并记录中医症候积分。结果 治疗后，对照组和治疗组的总有效率分别为62.50%、81.25%，治疗组明显优于对照组（P<0.05）。治疗后，2组中医证候积分均较治疗前降低（P<0.05），且治疗后，治疗组中医证候积分低于对照组（P<0.05）。治疗后，2组尿UAER、UACR及血脂、FPG、2hPG、HbA1C水平较治疗前明显降低（P<0.05）；PCX、nephrin水平较治疗前明显提高（P<0.05）；肾脏收缩期最大峰值流速（V_max）及肾脏血流阻力指数（resistent index，RI）较治疗前具有统计学差异（P<0.05）。治疗后，治疗组上述指标改善均优于对照组（P<0.05）。结论 芪羽水陆地黄汤治疗DN临床疗效较好，不但能降低血糖、调节血脂、降低尿蛋白，而且能改善肾脏血流动力学，提高血清PCX、nephrin水平，达到延缓肾脏损伤的作用。

Objective To investigate the clinical effect of Qiyu Shuilu Dihuang Decoction (芪羽水陆地黄汤) on early diabetic nephropathy (DN) based on the theory of "kidney dysfunction" and its influence on the level of podocalyxin (PCX), podocyte hiatus membrane protein (nephrin) and renal vascular ultrasound. Methods Stage III DN patients in the Department of Endocrinology, Affiliated Hospital of Shaanxi University of Chinese Medicine were selected and assigned to the control group (64 cases) and the treatment group (64 cases) according to random number table method. The control group was given routine treatment, and the treatment group was given Qiyu Shuilu Dihuang Decoction on the basis of the control group, and the treatment lasted for 3 months. The changes of urinary albumin excretion rate (UAER), urinary albumin creatinine ratio (UACR), blood lipid, fasting plasma glucose (FPG), 2-h postprandial glucose (2hPG), glycated hemoglobin (HbA1c), PCX, nephrin and renal vascular ultrasound in each group before and after treatment were detected and compared. Traditional Chinese medicine (TCM) syndrome scores were assessed and recorded. Results After treatment, the total effective rate of the control group and the treatment group was 62.50% and 81.25%, respectively, the treatment group was significantly better than the control group (P < 0.05). After treatment, the TCM syndrome score of both groups was lower than that before treatment (P < 0.05), and the TCM syndrome score of the treatment group was lower than that of the control group (P < 0.05). After treatment, the levels of urinary UAER, UACR and blood lipid, FPG, 2hPG and HbA1C in two groups were significantly lower than those before treatment (P < 0.05). The levels of PCX and nephrin were significantly higher than those before treatment (P < 0.05). The maximum peak flow rate of renal systole (V_max) and renal resistent index (RI) were statistically different from those before treatment (P < 0.05). After treatment, the above indexes in the treatment group were statistically different from those in the control group (P < 0.05). Conclusion Qiyu Shuilu Dihuang Decoction has a good clinical effect in the treatment of DN. It can not only reduce blood glucose, blood lipid and urinary protein, but also improve renal hemodynamicsincrease and serum PCX and nephrin levels, which can delay renal injury.

R285.64

陕西省科技厅一般项目（2020SF-336）；陕西省中医药管理局项目（LCMS038）；陕西省中医药管理局项目（JCPT005）