目的 探讨紫芪补肾汤联合达格列净治疗脾肾阳虚型糖尿病肾病（DKD）患者的临床疗效，并分析其对糖代谢、肾功能的影响。方法 选取2024年9月～2025年9月于本院就诊的106例DKD患者为研究对象，按照随机数字表法将其分为对照组、研究组，各53例。对照组予以达格列净治疗，研究组予以紫芪补肾汤联合达格列净治疗，连续治疗2个月。统计对比两组临床疗效、不良反应及治疗前后中医证候积分、血糖及糖代谢指标[空腹血糖（FPG）、餐后2 h血糖（2 h PG）、糖化血红蛋白（HbA1c）、糖原合酶激酶-3β（GSK-3β）、缺氧诱导因子-1α（HIF-1α）]、肾功能相关指标[血尿素氮（BUN）、血肌酐（SCr）、尿微量白蛋白排泄率（UAER）、估算的肾小球滤过率（eGFR）、同型半胱氨酸（Hcy）、胱抑素C（CysC）、碳水化合物反应元件结合蛋白（ChREBP）]、炎症因子[肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）、肿瘤坏死因子1型受体（TNFR1）、趋化因子配体9（CXCL9）]、血管内皮功能[血管生成抑制蛋白-1（VASH-1）、血管内皮生长因子（VEGF）、内皮素-1（ET-1）、一氧化氮（NO）、血栓素B2（TXB2）]。结果 研究组总有效率为90.57%，明显高于对照组的73.58%（P＜0.05）；研究组治疗后中医证候积分低于对照组（P＜0.05）；研究组治疗后FPG、2 h PG、HbA1c、GSK-3β、HIF-1α水平低于对照组（P＜0.05）；研究组治疗后BUN、SCr、UAER、Hcy、CysC、ChREBP水平低于对照组，eGFR高于对照组（P＜0.05）；研究组治疗后血清TNF-α、IL-1β、TNFR1、CXCL9水平低于对照组（P＜0.05）；研究组治疗后VASH-1、NO水平高于对照组，VEGF、ET-1、TXB2水平低于对照组（P＜0.05）；两组不良反应比较无明显差异（P＞0.05）。结论 紫芪补肾汤联合达格列净治疗DKD患者的疗效显著，可降低血糖水平，改善肾功能，抑制炎症反应，减轻血管内皮损伤，且具有一定安全性。

目的 探讨血清胱抑素C（Cys-C）联合β₂-微球蛋白（β₂-MG）早期诊断糖尿病肾病的应用价值。方法 选择2021年4月—2023年4月医院接收的100例糖尿病患者为对象,根据其有无合并肾脏疾病,将其分为糖尿病组及糖尿病肾病组,各50例,同比例选取同期到我院体检的健康人群50名进行对照研究,检测比较其Cys-C及β₂-MG水平,对比其Cys-C阳性率、β2-MG阳性率及联合检测阳性率,并对比不同疾病分期糖尿病肾病患者的Cys-C、β₂-MG水平。结果 糖尿病肾病患者Cys-C、β₂-MG水平高于糖尿病患者与健康者（P<0.05）。糖尿病患者Cys-C、β₂-MG水平高于健康者（P<0.05）。糖尿病肾病患者Cys-C阳性率64.00%、β₂-MG阳性率72.00%、Cys-C+β₂-MG联合检测阳性率96.00%高于糖尿病6.00%、10.00%、12.00%及健康者0.00%、0.00%、0.00%（P<0.05）;糖尿病Cys-C+β₂-MG联合检测阳性率12.00%高于健康者0.00%（P<0.05）;糖尿病肾病中Cys-C+β₂-MG联合检测阳性率96.00%高于CysC 64.00%、β₂-MG 72.00%（P<0.05）。糖尿病肾病不同分期患者Cys-C、β₂-MG水平比较,Ⅳ期>Ⅲ期>Ⅰ~Ⅱ期（P<0.05）。结论 糖尿病肾病患者Cys-C、β₂-MG水平明显升高,Cys-C、β₂-MG联合诊断更具有优势,而且肾损害越严重,Cys-C、β₂-MG异常程度越高,作为临床诊治的参考依据的价值较高。

Objective To investigate the application value of serum cystatin C（Cys-C）combined with β₂-microglobulin（β₂-MG）in the early diagnosis of diabetic nephropathy．Methods A total of 100 diabetic patients admitted to our hospital from April 2021 to April 2023 were selected as subjects,and divided into diabetes group and diabetic nephropathy group according to whether they have renal diseases or not,with 50 cases in each group．Then,50 healthy people who came to our hospital for physical examination in the same period were selected for comparative study,and their Cys-C and β₂-MG levels were detected and compared,and their Cys-C positive rate,β₂-MG positive rate and combined detection positive rate were compared．Results The levels of Cys-C and β₂-MG in patients with diabetic nephropathy were higher than those in patients with diabetes and healthy controls（P<0.05）．The levels of Cys-C and β₂-MG in diabetic patients were higher than those in healthy controls（P<0.05）．The positive rates of Cys-C（64.00%）,β₂-MG（72.00%）and Cys-C+β₂-MG（96.00%）in patients with diabetic nephropathy were higher than those in patients with diabetes（6.00%,10.00%,12.00%）and healthy subjects（0.00%,0.00%,0.00%）（P<0.05）．The positive rate of combined detection of Cys-C and β₂-MG in diabetic patients（12.00%）was higher than that in healthy subjects（0.00%）（P<0.05）．The positive rate of Cys-C combined with β₂-MG in diabetic nephropathy was 96.00%,which was higher than that of Cys-C 64.00% and β₂-MG 72.00%（P<0.05）．The levels of Cys-C and β₂-MG in patients with stage Ⅳ diabetic nephropathy were higher than those in patients with stage Ⅲ and Ⅰ-Ⅱ diabetic nephropathy（P<0.05）．The levels of Cys-C and β₂-MG in stage Ⅲ patients were higher than those in stage Ⅰ-Ⅱ patients（P<0.05）．Conclusions The levels of Cys-C and β₂-MG are significantly increased in patients with diabetic nephropathy,and the combination of Cys-C and β₂-MG has more advantages．The greater serious renal damage,the greater abnormal degree of Cys-C and β₂-MG,which has a higher value as a reference for clinical diagnosis and treatment．

目的 探究百令胶囊联合前列地尔对早期糖尿病肾病患者血液流变学及肾功能影响。方法 选我院2020年1月—2021年1月期间100例糖尿病肾病患者为研究对象,将其以随机数字表法分为对照组、观察组,各50例,分别应用前列地尔治疗、前列地尔+百令胶囊治疗,比较2组治疗前后血液流变学指标、肾功能指标。结果 治疗前2组血浆粘度、全血粘度、红细胞聚集指数水平相近,差异无统计学意义(P＞0.05);治疗后观察组血浆粘度、全血粘度、红细胞聚集指数水平较对照组低,差异有统计学意义(P＜0.05);治疗前2组微量蛋白排泄率(UAER)、血尿素氮(BUN)、血肌酐(Scr)水平相近,差异无统计学意义(P＞0.05);治疗后观察组UAER、BUN、Scr水平较对照组低,差异有统计学意义(P＜0.05);2组治疗期间均未见严重不良反应。结论 对早期糖尿病肾病患者应用百令胶囊+前列地尔治疗,可改善其血液流变学指标及肾功能指标,降低炎症反应程度,治疗安全且疗效理想。

Objective To explore the effect of Bailing capsule combined with alprostadil on hemorheology and renal function in patients with early diabetic nephropathy. Methods A total of 100 patients with diabetic nephropathy in our hospital from January 2020 to January 2021 were randomly divided into control group and observation group, 50 cases in each group.They were treated with alprostadil and alprostadil with Bailing capsule respectively.The indexes of hemorheology and renal function before and after treatment were compared between the two groups. Results Before treatment, the levels of plasma viscosity, whole blood viscosity and erythrocyte aggregation index of the two groups were similar, and the differences were not statistically significant (P > 0.05). After treatment, the levels of plasma viscosity, whole blood viscosity and erythrocyte aggregation index of the observation group were lower than those of the control group, and the differences were statistically significant (P<0.05). Before treatment, the levels of urine albumin excretion ratio, blood urea nitrogen and serum creatinine in the two groups were similar, and the differences were not statistically significant (P > 0.05). After treatment, the levels of urine albumin excretion ratio, blood urea nitrogen and serum creatinine in the observation group were lower than those in the control group, and the differences were statistically significant (P<0.05). There was no serious adverse reaction in the two groups during the treatment. Conclusion Bailing capsule combined with alprostadil in the treatment of early diabetic nephropathy can improve the indexes of hemorheology and renal function, lower the inflammatory reaction, and the treatment is safe and effective.

目的 探讨糖尿病肾病患者肾功能恶化的危险因素。 方法 采用回顾性队列研究分析山东省立第三医院2017年1月—2020年5月108例患者的临床数据。将病人分为糖尿病肾病肌酐翻倍组和不翻倍组,比较两组间临床数据的变化。结果 糖尿病肾病肌酐翻倍组的BUN、胱抑素C和ACR水平均高于肌酐不翻倍组;eGFR、CO₂、ALB、HGB均低于肌酐不翻倍组,差异有统计学意义(P<0.05)。而UA、GLU、血脂、糖化血红蛋白,糖尿病和高血压病史差异无统计学意义(P>0.05)。相关分析表明血肌酐与BUN、eGFR、胱抑素C、ACR呈正相关;与ALB,HGB和CO₂呈负相关。多元线性回归分析结果显示,eGFR,胱抑素C,ACR, ALB和HGB是糖尿病肾病肾功能恶化的影响因素(P<0.05)。结论 糖尿病肾病除检测肾功能的常规指标外,还可观察ACR、ALB和HGB水平的变化,对判断患者肾功能是否恶化有一定价值。

Objective To investigate the risk factors of renal function deterioration in patients with diabetic nephropathy. Methods Retrospective cohort study was used to analyze the clinical data of 108 patients from January 2017 to May 2020 in the Third Hospital of Shandong Province. Patients were divided into diabetic nephropathy creatinine doubling group and non-doubling group. The changes of clinical data in two groups were compared and the risk factors of renal function deterioration were analyzed. Results The levels of BUN、cystatin C and ACR in the creatinine doubling group were higher than those in the creatinine non-doubling group, and the levels of eGFR、CO₂、ALB、 HGB were lower than those in the creatinine non-doubling group, the differences were statistically significant (P<0.05). However, there were no significant differences in the levels of UA, blood glucose, blood lipid, glycosylated hemoglobin, the history of diabetes and hypertension (P>0.05). The correlation analysis showed that serum creatinine was positively correlated with BUN、 eGFR、cystatin C and ACR and negatively correlated with CO₂、ALB and HGB. The results of multiple regression analysis showed that eGFR、cystatin C、ACR、ALB and HGB were independent influencing factors of renal function deterioration(all P<0.05). Conclusion Diabetic nephropathy can not only notice the routine indexes of renal function, but also observe the changes of ACR、ALB and HGB levels, which has certain value for awareing the renal function deterioration in patients.

目的 本研究旨在探讨2型糖尿病不同程度肾病与chemerin、SOD及MDA的相关性。方法 选取2016年1月—2017年12月期间于广州市第一人民医院内分泌科门诊和住院的患者100例,根据尿白蛋白/肌酐比(ACR)分为正常尿蛋白组(NA组,n=33),微量白蛋白尿组(MA组,n=34)及大量蛋白尿组(CA组,n=33),另选取32例我院体检中心体检结果正常的正常健康人作为对照组(NC组,n=32),测定血糖、糖化血红蛋白、血肌酐、ACR、24小时尿蛋白定量、胆固醇、甘油三酯、SOD、MDA、chemerin等水平。结果 SOD的水平:NC组> NA组> MA组>CA组(P<0.05);MDA的水平:CA组>MA组>NA组>NC组(P<0.05);Chemerin水平:CA组>MA组>NA组>NC组(P<0.05)。相关性分析提示ACR与血清SOD呈负相关,与MDA、chemerin呈正相关。多元回归分析显示,病程、胆固醇、糖化血红蛋白、chemerin是影响ACR的主要因素。结论 Chemerin、MDA、SOD可能参与糖尿病肾病的发生发展,检测其水平可以在一定程度上反映2型糖尿病肾病患者的病情严重程度。

Objective To explore the relationship between different type of Type 2 diabetes nephropathy and chemerin,SOD,MDA. Methods A total of 100 inpatients and outpatients were enrolled in this study between January 2016 and December 2017 in Guangzhou First People's Hospital. They were divided into normal urinary protein group (NA group, n=33), microalbuminuria group (MA group, n=34) and massive proteinuria group (CA group, n=33) based on ACR. Another 32 healthy people were collected as a control group in medical examination center (NC group, n=32). The levels of blood sugar, glycated hemoglobin, serum creatinine, ACR, 24-hour urinary protein, cholesterol, triglyceride, SOD, MDA and chemerin were measured. Results The level of SOD: NC group > NA group > MA group > CA group (P< 0.05). The level of MDA: CA group > MA group > NA group > NC group (P< 0.05). The level of chemerin: CA group > MA group > NA group > NC group (P< 0.05). Correlation analysis showed that ACR was negatively correlated with serum SOD and positively correlated with MDA and chemerin. Multivariate logistic regression demonstrated that course of disease, CHOL, HbA1c and chemerin were the main factors affecting ACR. Conclusion Chemerin, MDA and SOD may be involved in the occurrence and development of diabetic nephropathy. Chemerin, MDA and SOD may reflect the severity of type 2 diabetic nephropathy

目的 探讨呼出气体中丙酮能否用于糖尿病肾病的早期诊断。方法 对健康对照组、2型糖尿病组(T2MD)和糖尿病肾病组(DN)分别采用气相色谱-质谱(GC-MS)法测定呼气丙酮含量、全自动生化仪的乳胶透射免疫比浊法测定尿微量白蛋白、酶速率法测试β-羟丁酸以及全自动尿液分析仪干化学法测定尿酮体,并对上述结果进行分析。结果 在T2MD组和DN组中呼气中的丙酮含量均高于健康对照组(P<0.01);在DN组,丙酮与尿微量白蛋白水平呈线性相关(r=0.79,P<0.05)。结论 检测呼气中的丙酮有助于糖尿病肾病的早期诊断,能及时反映病人肾脏损伤情况。

Objective To explore the early diagnosis of diabetic nephropathy by exhaled acetone. Methods Respectively using GC-MS method for the determination of exhaled acetone content, emulsion transmission turbidimetric immunoassay method in automatic biochemical analyzer for determination of urinary microalbumin, enzyme rate method for testing β-hydroxybutyric acidand and dry chemical method in urine automatic analyzer for determination of urine ketone on healthy control group, type-2 diabetes mellitus group(T2MD), and diabetic nephropathy group(DN), and the above results were analyzed. Results The exhale acetone level in T2MD and DN groups were higher than those in control group(P<0.01); In DN group, the level of exhale acetone with urinary microalbumin had a linear correlation. Conclusion The detection of exhale acetone is helpful to early diagnosis in diabetic nephropathy, also may reflect the renal injury promptly.

目的 观察养血祛瘀方联合血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体拮抗剂(ARB)类药物对糖尿病肾病不同分期的疗效。方法 134例糖尿病肾病患者采用随机区组设计方案,以初诊时间(月份)作为配伍因素,随机分为治疗组67例和对照组67例,两组均采用常规西医综合基础治疗,对照组给予ACEI或ARB类药物治疗,治疗组在对照组治疗的基础上联用养血祛瘀方治疗,观察60 d,分析两组治疗前后24h尿微量白蛋白、24 h尿蛋白定量、血清C反应蛋白(hs-CRP)的变化。结果 对于糖尿病肾病Ⅲ期患者,治疗组较对照组尿蛋白减少,但差异无统计学意义(P＞0.05),治疗组较对照组hs-CRP水平明显下降(P＜0.05);对于糖尿病肾病Ⅳ期患者,治疗组较对照组尿蛋白减少(P＜0.05),治疗组较对照组hs-CRP水平下降(P＜0.05)。结论 养血祛瘀方联合ACEI或ARB类药物可有效减少糖尿病肾病Ⅳ期患者蛋白尿,降低糖尿病肾病患者hs-CRP水平。

Objective To investigate the efficacy of Yang Xue Qu Yu Fang combined with ARB/ACEI on different stages of diabetic nephropathy. Mehtods 134 patients who suffered from diabetic nephropathy were randomly divided into observation group and control group, each of them had 67 cases. The experiment use randomized block design and choose the time (months) of initial diagnosis as the compatibility factors. Both groups were treated by conventional therapy. The control group was given medicine of ARB/ACEI while the observation group was added Yang Xue Qu Yu Fang on the basis of control group. We observed all the patients for 60 days, to compare the microalbuminuria in urine of 24h, the urinary protein of 24h and the serum high sensitive C-reaction protein (Hs-CRP) between two groups before and after treatment. Results For patients of the 3rd stage of diabetic nephropathy, the albuminuria in observation group decreased obviously, but there was no significant difference between two groups (P>0.05), the serum Hs-CRP in observation group decreased obviously (P<0.05). For patients of the 4rd stage of diabetic nephropathy, the albuminuria in observation group decreased obviously (P<0.05), the serum Hs-CRP in observation group decreased obviously (P<0.05). Conclusion The Yang Xue Qu Yu Fang combined with ARB/ACEI can effectively reduce the albuminuria and can obviously lower the Hs-CRP level in the patients of the 4rd stage of diabetic nephropathy.

目的 探讨2型糖尿病肾病(DN)患者肾组织中STOML2的表达及作用。方法 免疫组化检测临床2型糖尿病肾病患者肾组织STOML2的表达及定位,采用慢病毒转染方法建立稳定过表达STOML2的HK-2细胞系,并应用Western blot检测肾小管上皮细胞钙粘蛋白(E-cadherin)、Fibronectin和STOML2的表达。结果 STOML2在DN患者肾组织的肾小管上皮细胞胞浆中表达明显升高。在高糖刺激HK-2细胞建立的EMT模型中,STOML2呈时间依赖表达上调。STOML2稳定高表达时,E-cadherin表达下调,而Fibronectin明显上调,即能促进肾小管上皮细胞发生EMT。结论 STOML2可能通过促进肾小管上皮细胞向间充质细胞分化,进而参与糖尿病肾病肾脏纤维化的发生发展。

Objective To investigate the expression and role of STOML2 in renal tissue of patients with type 2 diabetic nephropathy. Methods To detect he expression and localization of STOML2 in clinical renal tissue in patients with type 2 diabetic nephropathy by immunohistochemistry, and use lentiviral transfection method to establish a stable cell line of over-expressing STOML2, lastly apply western blot to detect the expression of E-cadherin, Fibronectin and STOML2 in renal tubular epithelial cells. Results STOML2 was significantly increased in renal tubular epithelial cytoplasm of patients with DN. In the EMT model of HK-2 cells stimulated by high glucose, STOML2 was increased in a time dependent. Overexpression of STOML2 led to E-cadherin down-regulated, while Fibronectin up-regulated, which promoted the occurrence of EMT in renal tubular epithelial cells. Conclusion STOML2 may be involved in the development and progression of renal fibrosis in diabetic nephropathy by mediating epithelial- mesenchymal transition of renal tubular epithelial cells.

       糖尿病肾病（DN）是指由糖尿病所致的慢性肾脏疾病，是目前我国和全球范围内慢性肾脏疾病和终末期肾脏疾病的首位病因。DN发病率逐年攀升，且预后不良，已成为我国重大的公共卫生问题之一。DN不仅明显降低了患者的生活质量，还增加了心血管疾病的风险。随着对DN发病机制的深入研究，近十余年来在DN治疗手段方面取得了显著进展，包括新型药物的研发、生活方式的干预及各种新兴疗法的探索。本文旨在系统性综述近年来DN领域的重要治疗进展，阐明这些进展在临床应用中的有效性和适用性，并展望未来的研究方向，以期为临床实践提供参考和指导。

       Diabetic nephropathy（DN）is a form of chronic kidney disease（CKD）induced by diabetes．Diabetic nephropathy represents the leading cause of CKD and end-stage renal disease both in China and globally．The incidence of DN has been steadily increasing and its prognosis remains unfavorable．Diabetic nephropathy has become a major public health concern．Diabetic nephropathy not only significantly affects patients’ quality of life but also increases the risk of cardiovascular diseases．Recent advancements in our understanding of the pathogenesis of DN have facilitated significant progress in treatment options over the past decade．These developments include the introduction of novel pharmacological agents，the implementation of lifestyle modifications，and the exploration of various emerging therapeutic approaches．This  review aims to  systematically expound the significant therapeutic advancements in the field of DN in recent years，evaluate the efficacy and applicability of these advancements in clinical practice，and explore potential future research directions，thereby providing valuable insights andguidance for clinical practice．