目的：观察益肾泄浊活血方联合前列地尔治疗糖尿病肾病（DKD） 的临床疗效。方法：选取80 例 DKD 患者为研究对象，采用随机数字表法随机分为对照组与观察组各41 例。对照组予常规治疗，观察组在对 照组基础上予以益肾泄浊活血方联合前列地尔治疗，共治疗8 周。比较2 组临床疗效，并比较2 组治疗前后血 液流变学指标及血清基质金属蛋白酶-9（MMP-9）、基质金属蛋白酶抑制剂-1（TIMP-1） 水平。结果：治疗 后，2 组24 小时尿蛋白定量（24 hPRO）、微量蛋白尿（mAlb）、β2-微球蛋白（β2-MG） 及胱抑素C（CysC） 水平均降低（P＜0.05），且观察组低于对照组（P＜0.05）。治疗后，2 组全血高切黏度（ηbH）、全血低切黏 度（ηbL）、血浆黏度（ηp）、红细胞聚集指数（AI） 水平均降低（P＜0.05），且观察组低于对照组（P＜ 0.05）。治疗后，2 组MMP-9、MMP-9/TIMP-1 均升高（P＜0.05），TIMP-1 下降（P＜0.05），且观察组血清 MMP-9、MMP-9/TIMP-1 均高于对照组（P＜0.05），TIMP-1 低于对照组（P＜0.05）。结论：益肾泄浊活血方 联合前列地尔在减少DKD 患者蛋白尿、保护肾功能方面效果显著，临床疗效优于单纯西医治疗，其机制可能 与其能有效调节DKD 患者MMP-9、TIMP-1 表达，改善患者血液流变学，降低血液高黏状态有关。
Abstract： Objective： To observe the clinical effect of Yishen Xiezhuo Huoxue Prescription combined with Alprostadil on diabetic kidney disease (DKD). Methods： A total of 80 cases of DKD patients were selected as research objects and randomly divided into the control group and the observation group according to the random number table method，with 41 cases in each group. The control group was given routine treatment， and the observation group was additionally treated with Yishen Xiezhuo Huoxue Prescription combined with Alprostadil based on the treatment of the control group. Both groups were treated for 8 weeks. The clinical effects were compared between the two groups； the hemorheology indexes and the levels of matrix metalloproteinase- 9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP- 1) in serum were compared before and after treatment between the two groups. Results： After treatment， the levels of 24- hour urinary protein quantitation (24 hPRO)， microalbuminuria (mAIb)， β2- microglobulin (β2-MG)，and cystatin C (CysC) in the two groups were decreased (P＜0.05)，and the above levels in the observation group were lower than those in the control group (P＜0.05). After treatment，the levels of whole blood high-shear viscosity (ηbH)，whole blood low-shear viscosity (ηbL)，plasma viscosity (ηp) and red blood cell aggregation indexes (AI) in the two groups were decreased (P＜0.05)，and the above levels in the observation group were lower than those in the control group (P＜0.05). After treatment， MMP- 9 and MMP- 9/TIMP- 1 in the two groups were increased (P＜0.05)，and TIMP- 1 was decreased (P＜0.05)；MMP-9 and MMP-9/TIMP-1 in serum in the observation group were higher than those in the control group (P＜0.05)， and TIMP- 1 was lower than that in the control group (P＜0.05). Conclusion： Yishen Xiezhuo Huoxue Prescription combined with Alprostadil has significant effects on reducing proteinuria and protecting kidney function of DKD patients，and its clinical effect is better than that of simple western medicine. The mechanism may be related to its ability to effectively regulate the expressions of MMP-9 and TIMP-1 in DKD patients，improve their hemorheology and reduce blood hyperviscosity.