目的 观察百令胶囊辅助缬沙坦治疗IgA肾病效果及对患者肾功能、细胞免疫调节、尿足细胞标志蛋白的影响。方法 选取2019年5月—2021年5月西部战区总医院肾内科收治经肾活检确诊为IgA肾病,筛选治疗方案中尚未使用激素及免疫抑制剂的80例患者,按住院先后顺序随机分为观察组和对照组,每组各40例。对照组给予缬沙坦治疗,观察组给予百令胶囊辅助缬沙坦治疗,治疗12周后,比较2组的疗效、治疗前后肾功能指标[24 h蛋白尿(24 h Upro)、尿素氮(BUN)、血肌酐(SCr)、尿红细胞(RBC)计数]、1型/2型辅助性T细胞(Th1/Th2)代表细胞因子[γ-干扰素(IFN-γ)、白介素-4(IL-4)]、尿足细胞标志蛋白[尿足萼糖蛋白(PCX)、尿足细胞B7-1分子(B7-1)]水平。结果 治疗12周后,观察组的治疗总有效率为95.0%,高于对照组的82.5%;观察组的24 h Upro、BUN、SCr、尿RBC计数低于对照组,IFN-γ、Th1/Th2低于对照组、IL-4高于对照组,尿PCX、B7-1水平低于对照组;差异均有统计学意义(P<0.05)。结论 百令胶囊辅助缬沙坦治疗IgA肾病患者,可以提高临床疗效,有效保护患者肾功能,调节其免疫状态,减轻肾损伤。

Objective To observe the effects of Bailing capsules assisting valsartan in the treatment of IgA nephropathy and its influence on renal function, cellular immune regulation and urine prodocytes marker protein. Methods From May 2019 to May 2021, 80 patients with IgA nephropathy confirmed by renal biopsy in the Nephrology Department of Western Theatre Command General Hospital, who had not used hormones or immunosuppressants in the treatment were selected.Patients were divided into observation group and control group according to the order of hospitalization, 40 cases in each group.The control group was given valsartan, and the observation group was given Bailing capsules and valsartan.After 12 weeks of treatment, the efficacy, the levels of renal function indexes [24 h proteinuria (24 h Upro), urea nitrogen (BUN), serum creatinine (SCr), urinary red blood cell (RBC) count], type 1/type 2 helper T cells (Th1/Th2) represent cytokines [interferon-γ (IFN-γ), interleukin-4 (IL-4)], urine prodocytes marker protein [urine podocalyxin (PCX), urinary podocyte B7-1 molecule (B7-1)] before and after treatment were compared between the two groups. Results After treatment, the total effective rate in observation group was higher than that in control group (95.0% vs 82.5%).The 24 h Upro, BUN, SCr levels and urine RBC count in observation group were lower than those in control group, IFN-γ and Th1/Th2 levels were lower than those in control group, the IL-4 level was higher than that in control group, and the levels of urine PCX and B7-1 were lower than those in control group.Those differences were statistically significant (P<0.05). Conclusions Bailing capsules assisting valsartan in the treatment of IgA nephropathy can improve clinical efficacy, effectively protect the renal function of patients, regulate the immune status, and alleviate renal injury.

        目的   分析达格列净联合沙库巴曲缬沙坦治疗射血分数降低的心力衰竭（HFrEF）效果。方法  连续抽取2021年1月—2023年6月在广州市第一人民医院心内科住院的射血分数降低的心力衰竭（HFrEF）患者203例，随访至少6个月，按照接受的治疗进行分组。对照组予常规治疗和沙库巴曲缬沙坦治疗；观察组予常规治疗、沙库巴曲缬沙坦和达格列净治疗；对比两组疗效，观察指标包括住院时间，入院及出院后6个月的心功能状态（NYHA纽约心脏病协会心功能分级）、心脏超声指标左室射血分数（LVEF）、左室舒张末内径（LVEDD）、左室收缩末内径（LVSDD）、血液指标-端脑钠肽前体（NT-proBNP N）、糖化血红蛋白（HBA1c）、血肌酐（Cr）、6个月时的再住院率及全因死亡率。结果   观察组心脏监护病房（CCU）停留时间（2.54±1.26）d，短于对照组的（3.73±1.21）d；观察组6个月时观察组心功能NYHA改善≥2级比例为95.05%高于对照组的86.27%，差异有统计学意义（P＜0.05）；观察组6个月时的LVEDD、LVESD水平分别为（48.22±7.35）（34.61±4.32）mm，低于对照组的（51.47±8.02）（43.07±5.33）mm，LVEF为（51.49±5.40）%，高于对照组的（46.18±4.21）%，差异有统计学意义（P＜0.05）；6个月时观察组的NT-proBNP为（415.58±31.57）pg/mL，低于对照组的（520.23±385.56）pg/mL，差异有统计学意义（P＜0.05）；两组的住院时间、血清肌酐（Cr）、HBA1c、6个月时的再住院率、全因病死率对比，差异不显著（P＞0.05）。观察组HBA1c值为（6.04±0.66）mmol/L，高于对照组的（5.20±0.56）mmol/L（P＜0.05）。结论  HFrEF患者采取达格列净+沙库巴曲缬沙坦治疗，可通过协同作用，缩短CCU停留时间，改善患者6个月时的心功能状态，降低NT-proBNP值，减少心脏扩大趋势，提高LVEF水平。

       Objective  To analyze the efficacy of  dapagliflozin combined with  sacubitril/valsartan in the treatment of heart failure with reduced ejection fraction（HFrEF）．Methods  A total of 203 patients with HFrEF who were hospitalized in the cardiology department of the hospital between January 2021 and June 2023 were enrolled and followed up for at least six months．Patients were divided into groups based on their treatment regimens：the control group received conventional treatment plus sacubitril/valsartan，while the observation group received conventional treatment plus sacubitril/valsartan and dapagliflozin．The two groups were compared for clinical outcomes，including length of hospital stay，cardiac function（NYHA classification）at admission and six months after discharge，echocardiographic indicators（LVEF，LVEDD，LVESD），blood indicators（NT-proBNP，HbA1c，creatinine），six-month rehospitalization rate，and all-cause mortality．Results  The observation group had a shorter CCU stay（2.54±1.26 days）compared to the control group（3.73±1.21 days）．At sixth month，the proportion of patients in the observation group with an NYHA improvement ≥2 grades（95.05%）was significantly higher than that in the control group（86.27%）（P＜0.05）．The observation group demonstrated lower LVEDD（48.22±7.35 mm）and LVESD（34.61±4.32 mm）levels and higher LVEF（51.49±5.40%）compared to the control group（LVEDD：［51.47±8.02］ mm，LVESD：［43.07±5.33］mm，LVEF：［46.18±4.21］%）（P＜0.05）．NT-proBNP levels in the observation group（［415.58±31.57］ pg/mL）were significantly lower than those in the control group（［520.23±385.56］ pg/ml）（P＜0.05）．There were no significant differences between the two groups in length of total hospital stay，serum creatinine，HbA1c，six-month rehospitalization rate，or all-cause mortality（P＞0.05）．However，HbA1c levels in the observation group（［6.04±0.66］ mmol/L）were higher than those in the control group（［5.20±0.56］ mmol/L）（P＜0.05）．Conclusions  The combination of dapagliflozin and sacubitril/valsartan in the treatment of HFrEF patients can exert a synergistic effect，shorten CCU stay，improve cardiac function at sixth month，reduce NT-proBNP levels，mitigate cardiac dilation，and increase LVEF．