目的 探討尿毒清顆粒聯(lián)合貝那普利治療早期糖尿病腎病的臨床效果。方法 選取2017年6月—2021年6月天津市第五中心醫(yī)院收治的300例早期糖尿病腎病患者，運(yùn)用隨機(jī)數(shù)字表法將300例患者隨機(jī)分成對照組和治療組，每組各150例。對照組口服鹽酸貝那普利片，10mg/次，1次/d。治療組在對照組基礎(chǔ)上口服尿毒清顆粒（無糖型），每日6∶00、12∶00、18∶00時(shí)各服1袋，22∶00時(shí)服2袋，溫開水沖服。兩組均連續(xù)治療12周。觀察兩組臨床療效，比較治療前后兩組腎功能指標(biāo)[肌酐（Cr）、尿素氮（BUN）和24h尿蛋白定量（24h UP）]、歐洲五維健康量表（EQ-5D）評分、腎葉間動脈血流動力學(xué)參數(shù)[收縮期峰值血流速度（V_max）、舒張末期血流速度（V_min）、阻力指數(shù)（RI）]及血清基質(zhì)金屬蛋白酶9（MMP-9）、丙二醛（MDA）、轉(zhuǎn)化生長因子β1（TGF-β1）、血管內(nèi)皮生長因子（VEGF）水平。結(jié)果 治療后，治療組總有效率是92.7%，顯著高于對照組的80.7%（P<0.05）。治療后，兩組血清Cr、BUN水平及24h UP均顯著低于治療前（P<0.05）；且均以治療組降低更顯著（P<0.05）。治療后，兩組EQ-5D指數(shù)、EQ-VAS評分均較治療前顯著增加（P<0.05）；且均以治療組升高更顯著（P<0.05）。治療后，兩組腎葉間動脈V_max、V_min均顯著增高，腎葉間動脈RI則均顯著降低（P<0.05）；且均以治療組改善更顯著（P<0.05）。治療后，兩組血清MMP-9水均顯著升高，血清MDA、TGF-β1和VEGF水平均顯著降低（P<0.05）；且治療后，治療組血清MMP-9水平高于對照組，MDA、TGF-β1和VEGF水平低于對照組（P<0.05）。結(jié)論 尿毒清顆粒聯(lián)合貝那普利治療早期糖尿病腎病的整體療效滿意，是改善患者腎功能和提高生活質(zhì)量的安全有效途徑，并能進(jìn)一步升高血中MMP-9水平及下調(diào)血中MDA、TGF-β1、VEGF的水平，值得臨床推廣。

Objective To investigate the clinical effect of Niaoduqing Granules combined with benazepril in treatment of early diabetic nephropathy. Methods A total of 300 patients with early diabetic nephropathy admitted to Tianjin Fifth Central Hospital from June 2017 to June 2021 were selected and randomly divided into control group and treatment group by random number table method, with 150 cases in each group. Patients in the control group were po administered with Benazepril Hydrochloride Tablets, 10 mg/time, once daily. Patients in the treatment group were po administered with Niaoduqing Granules (sugar-free type) on the basis of the control group, took one bag with warm boiling water at 6, 12 and 18 o’clock every day, and two bags at 22 o’clock. Both groups were treated for 12 weeks. The clinical effect of the two groups was observed, the renal function indexes [creatinine (Cr), blood urea nitrogen (BUN) and 24-hour urine protein quantitative (24-hour UP)], European five-dimensional health before and after treatment between the two groups. Scale (EQ-5D) score, renal interlobar artery hemodynamic parameters [peak systolic blood velocity (V_max), end-diastolic blood velocity (V_min), resistance index (RI)] and serum matrix metalloproteinase 9 (MMP-9), malondialdehyde (MDA), transforming growth factor β1 (TGF-β1), vascular endothelial growth factor (VEGF) levels in two groups before and after treatment were compared. Results After treatment, the total effective rate of the treatment group was 92.7%, which was significantly higher than that of the control group (80.7%, P< 0.05). After treatment, the serum levels of Cr, BUN and 24 h UP in the two groups were significantly lower than those before treatment (P< 0.05). And the reduction was more significant in the treatment group (P< 0.05). After treatment, the EQ-5D index and EQ-VAS score of the two groups were significantly increased compared with those before treatment (P< 0.05). The increase was more significant in the treatment group (P< 0.05). After treatment, V_max and V_min of renal interlobar artery were significantly increased, while RI of renal interlobar artery was significantly decreased in both groups (P < 0.05). The improvement was more significant in the treatment group (P < 0.05). After treatment, serum MMP-9 water was significantly increased, while serum MDA, TGF-β1 and VEGF levels were significantly decreased in the two groups (P < 0.05). After treatment, the serum levels of MMP-9 in the treatment group were higher than those in the control group, and the levels of MDA, TGF-β1 and VEGF were lower than those in the control group (P < 0.05). Conclusion Niaoduqing Granules combined with benazepril has a definite clinical effect in treatment of early diabetic nephropathy, can safely and effectively protect the renal function of patients, improve the life quality, and can further increase the level of MMP-9 in blood and down-regulate the level of MDA, TGF-β1 and VEGF, which is worthy of clinical promotion.

R977

天津市第五中心醫(yī)院院內(nèi)科研項(xiàng)目（WZX201909）