【摘要】 目的 观察非奈利酮联合沙库巴曲缬沙坦及达格列净口服治疗早期糖尿病肾病的临床效果。方法 选取早期2型糖尿病肾病患者68例为研究对象。在年龄、性别等基线资料组间均衡可比的原则下，分为对照组33例、试验组35例。对照组给予沙库巴曲缬沙坦及达格列净治疗，试验组在对照组基础上给予非奈利酮治疗，共治疗12个月。对比两组治疗前后的肾功能指标[血肌酐（Cr）、尿素氮（BUN）、估计肾小球滤过率（eGFR）、尿酸（UA）、尿微量白蛋白（MALB）、尿微量白蛋白/尿肌酐（ACR）]、血糖指标[空腹血糖（FPG）、糖化血红蛋白（HbA1c）]、血压指标[收缩压（SBP）、舒张压（DBP）]、血钾和炎症相关指标[白细胞计数（WBC）、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)]，记录并比较两组不良反应发生情况（如头痛头晕、恶心呕吐、高钾血症、低血压等）。结果 两组治疗后BUN、MALB、ACR、HbA1c、FPG、SBP、DBP、WBC、IL-6、TNF-α均较治疗前降低（P均<0.05）。试验组治疗12个月的Cr水平低于对照组，治疗12个月的eGFR、血钾高于对照组，治疗6、12个月的BUN、MALB、ACR低于对照组，治疗3、6、12个月的WBC、IL-6、TNF-α、SBP低于对照组（P均<0.05）。两组头痛头晕、恶心呕吐、高钾血症、低血压发生率差异无统计学意义（P均>0.05）。结论 非奈利酮联合沙库巴曲缬沙坦及达格列净口服治疗早期糖尿病肾病能够有效减少尿蛋白、改善肾功能、控制血糖和炎症反应，且有助于长期血压管理，但非奈利酮应用过程中有升高血钾的风险，需定期检测血钾水平。更多还原

【Abstract】 Objective To explore the clinical effects of oral treatment with finerenone combined with sacubitril/valsartan and dapagliflozin on early diabetic kidney disease. Methods Sixty-eight patients with early type 2 diabetic nephropathy were selected as the study subjects. Under the principle of balanced and comparable baseline data such as age and gender, the subjects were divided into the control group of 33 cases and experimental group of 35 cases. The control group was treated with sacubitril/valsartan and dapagliflozin, while the experimental group was treated with finerenone in addition to the treatment of the control group for a total of 12 months. We compared the renal function indicators [serum creatinine(Cr), blood urea nitrogen(BUN), estimated glomerular filtration rate(eGFR), uric acid(UA), urinary microalbumin(MALB), and urinary microalbumin-to-creatinine ratio(ACR)], blood glucose indicators [fasting blood glucose(FPG) and glycosylated hemoglobin A1c(HbA1c)], blood pressure indicators [systolic blood pressure(SBP) and diastolic blood pressure DBP], blood potassium and inflammation related indicators [white blood cells(WBC), interleukin-6(IL-6), and tumor necrosis factor-α(TNF-α)] before and after treatment between two groups, and recorded and compared the occurrence of adverse reactions(headache, dizziness, nausea, vomiting, hyperkalemia, and hypotension) between the two groups. Results After treatment, BUN, MALB, ACR, HbA1c, FPG, SBP, DBP, WBC, IL-6, and TNF-α in both groups decreased in comparison with those before treatment(all P<0. 05). The Cr level in the experimental group was lower than that in the control group after 12 months of treatment, while eGFR and blood potassium levels were higher than those in the control group after 12 months of treatment. BUN, MALB, and ACR levels were lower than those in the control group after 6 and 12 months of treatment. WBC, IL-6, TNF-α, and SBP levels were lower than those in the control group after 3, 6, and 12 months of treatment(all P<0. 05). There were no statistically significant differences in the incidence of headache, dizziness, nausea and vomiting, hyperkalemia, or hypotension between the two groups(all P>0. 05). Conclusions Oral treatment of early diabetic kidney disease with finerenone combined with sacubitril/valsartan and dapagliflozin can effectively reduce urinary protein, improve renal function, control blood sugar and inflammatory reaction, and help long-term blood pressure management. However, there is a risk of increasing blood potassium during the use of finerenone, and blood potassium levels need to be regularly measured.更多还原