目的 分析玉屏風(fēng)顆粒聯(lián)合潑尼松和環(huán)孢素治療特發(fā)性膜性腎病的臨床療效。方法 選取河池市中醫(yī)醫(yī)院在2020年3月—2022年7月收治的90例特發(fā)性膜性腎病患者，隨機(jī)分為對照組和治療組，每組各45例。對照組口服醋酸潑尼松片，起始劑量為1 mg/(kg∙d)，共服用4周，此后每周減量10 mg維持；同時口服環(huán)孢素膠囊，劑量為3～5 mg/(kg∙d)，1次/12 h。治療組在對照組方案基礎(chǔ)上口服玉屏風(fēng)顆粒，5 g/次，3次/d。兩組患者治療3個月。觀察兩組患者臨床療效，比較治療前后兩組患者中醫(yī)證候積分，腎功能指標(biāo)24 h尿蛋白定量（24 h UP）、血尿素氮（BUN）、血清肌酐（Scr）和血清白蛋白（Alb），及Th17/Treg免疫平衡指標(biāo)。結(jié)果 治療后，治療組臨床有效率為（91.11%）明顯高于對照組（73.33%，P＜0.05）。治療后，兩組患者中醫(yī)癥候積分均有降低（P＜0.05）；治療組主要中醫(yī)證候積分均明顯低于對照組（P＜0.05）。治療后，兩組患者24 h UP、BUN、Scr、Th17、Th17/Treg明顯低于治療前，而Alb和Treg高于治療前（P＜0.05），且治療組腎功能指標(biāo)和免疫指標(biāo)明顯好于對照組（P＜0.05）。結(jié)論 玉屏風(fēng)顆粒聯(lián)合潑尼松和環(huán)孢素治療特發(fā)性膜性腎病臨床療效顯著，可改善患者主要中醫(yī)癥候和腎功能指標(biāo)，調(diào)節(jié)Th17/Treg免疫平衡態(tài)，治療安全性較好。

Objective To analyze the clinical efficacy of Yupingfeng Granules combined with prednisone and cyclosporine in treatment of idiopathic membranous nephropathy. Methods Patients (90 cases) with idiopathic membranous nephropathy in Hechi Traditional Chinese Medicine Hospital from March 2020 to July 2022 were randomly divided into control and treatment group, and each group had 45 cases. Patients in the control group were po administered with Prednisone Acetate Tablets, the initial dose was 1 mg/(kg·d) for 4 weeks, followed by a reduction of 10 mg per week, while Cyclosporine Capsules were taken orally at a dose of 3-5 mg/(kg·d), once per 12 h. Patients in the treatment group were po administered with Yupingfeng Granules on the basis of the control group, 5 g/time, three times daily. Patients in two groups were treated for 3 months. After treatment, the clinical evaluation was evaluated, and the TCM symptom scores, renal function indexes 24 h UP, BUN, Scr and Alb, and Th17/Treg immune balance indexes in two groups before and after treatment were compared. Results After treatment, the clinical effective rate of the treatment group (91.11%) was significantly higher than that of the control group (73.33%, P < 0.05). After treatment, TCM symptom scores were decreased in both groups (P < 0.05), and the scores of main TCM symptoms in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, 24 h UP, BUN, Scr, Th17 and Th17/Treg in two groups were significantly lower than those before treatment, while Alb and Treg were higher, and the renal function and immune indexes in the treatment group were significantly better than those in the control group (P < 0.05). Conclusion Yupingfeng Granules combined with prednisone and cyclosporine is effective in the treatment of idiopathic membranous nephropathy, which can improve the main TCM symptoms and renal function indexes, regulate the immune balance of Th17/Treg, and the treatment is safe.

R983

廣西壯族自治區(qū)中醫(yī)藥管理局自籌經(jīng)費(fèi)科研項(xiàng)目（GZZC2020335）