目的 探討益腎化濕顆粒聯(lián)合坎地沙坦酯治療糖尿病腎病的有效性與安全性。方法 選取2016年1月—2017年1月在山東中醫(yī)藥大學(xué)第二附屬醫(yī)院治療的糖尿病腎病患者145例，根據(jù)用藥方案的不同分成對(duì)照組（72例）和治療組（73例）。對(duì)照組患者口服坎地沙坦酯片，2片/次，1次/d；治療組在對(duì)照組的基礎(chǔ)上口服益腎化濕顆粒，1袋/次，3次/d。所有患者均治療1個(gè)月。觀察兩組患者臨床療效，比較治療前后兩組患者炎癥因子水平、糖化血紅蛋白（HbA1c）、內(nèi)脂素水平、24 h尿蛋白定量、血肌酐、尿素氮和不良反應(yīng)情況。結(jié)果 治療后，對(duì)照組和治療組臨床總有效率分別為84.72%和97.26%，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組患者腫瘤壞死因子-α和白細(xì)胞介素-6水平顯著降低（P<0.05）；且治療組患者上述炎癥因子水平降低更明顯（P<0.05）。治療后，兩組患者HbA1c和內(nèi)脂素水平顯著降低（P<0.05）；且治療組患者HbA1c和內(nèi)脂素水平明顯低于對(duì)照組（P<0.05）。治療后，兩組患者24 h尿蛋白定量、血肌酐和尿素氮水平均顯著均下降（P<0.05）；且治療組患者上述各指標(biāo)明顯低于對(duì)照組（P<0.05）。治療期間，治療組患者不良反應(yīng)發(fā)生率為2.74%，明顯低于對(duì)照組的13.89%，兩組患者比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 益腎化濕顆粒聯(lián)合坎地沙坦酯治療糖尿病腎病具有療效好、安全性高的特點(diǎn)，具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To explore the efficacy and safety of Yishen Huashi Granules combined with candesartan in treatment of diabetic nephropathy. Methods Patients (145 cases) with diabetic nephropathy in the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 2016 to January 2017 were divided into control (72 cases) and treatment (73 cases) according to different treatment. Patients in the control group were po administered with Candesartan Cilexetil Tablets, 2 tablets/time, once daily. Patients in the treatment group were po administered with Yishen Huashi Granules on the basis of the control group, 1 bag/time, three times daily. Patients in two groups were treated for 1 month. After treatment, the clinical efficacy was evaluated, and the levels of inflammatory factors, HbA1c, Visfatin, 24 h urine protein quantitative, serum creatinine and urea nitrogen, and the adverse reactions in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 84.72% and 97.26% respectively, and there were differences between two groups (P < 0.05). After treatment, the tumor necrosis factor-α and IL-6 levels in two groups were significantly decreased (P < 0.05). And these inflammatory factors levels in the treatment group after treatment were significantly lower than those in the control group (P < 0.05). After treatment, the HbA1c and visfatin levels in two groups were significantly decreased (P < 0.05). And the HbA1c and visfatin levels in the treatment group after treatment were significantly lower than those in the control group (P < 0.05). After treatment, the 24 h urine protein quantitative, serum creatinine and urea nitrogen levels in two groups were significantly decreased (P < 0.05). And these indicators level in the treatment group after treatment was significantly lower than that in the control group (P < 0.05). During the treatment, the incidence of adverse reactions in the treatment group was 2.74%, which was significantly lower than 13.89% in the control group, with significant difference between two groups (P < 0.05). Conclusion Yishen Huashi Granules combined with candesartan has good curative effect and high safety in treatment of diabetic nephropathy, which has a certain clinical application value.