【目的】观察益气化瘀汤（由黄芪、山药、茯苓、炒芡实、旱莲草、金樱子、焦山楂、女贞子、丹参、益母草等组成） 联合羟苯磺酸钙治疗糖尿病肾病（DN）气虚血瘀证的临床疗效及对血管内皮生长因子（VEGF）、胰岛素样生长因子1（IGF-1） 的影响。【方法】将90例DN气虚血瘀证患者随机分为观察组和对照组，每组各45例。所有患者均接受基础降糖治疗和控制 血压、调节脂代谢紊乱等治疗。在此基础上，对照组患者给予羟苯磺酸钙治疗，观察组患者在对照组的基础上联合益气化 瘀汤治疗，疗程为3个月。观察2组患者治疗前后中医证候积分、肾功能指标及血清VEGF、IGF-1水平的变化情况，并评价 2组患者的临床疗效。【结果】（1）疗效方面，治疗3个月后，观察组的总有效率为91.11%（41/45），对照组为75.56%（34/45）， 组间比较（χ2检验），观察组的疗效明显优于对照组（P＜0.05）。（2）中医证候积分方面，治疗1个月和3个月后，2组患者的中 医证候积分均较治疗前明显降低（P＜0.05），且治疗3个月后又均较治疗1个月后明显降低（P＜0.05）；组间比较，观察组在 治疗1个月和3个月后对中医证候积分的降低作用均明显优于对照组（P＜0.01）。（3）肾功能指标方面，治疗后，2组患者的血 肌酐（Scr）、尿素氮（BUN）、肾小球滤过率（GFR）等肾功能指标均较治疗前明显改善（P＜0.05），且观察组对各项肾功能指标 的改善作用均明显优于对照组（P＜0.01）。（4）血清VEGF、IGF-1水平方面，治疗后，2组患者的血清VEGF、IGF-1水平均较 治疗前明显降低（P＜0.05），且观察组对血清VEGF、IGF-1水平的降低作用均明显优于对照组（P＜0.01）。（5）治疗过程中， 2组患者均无明显不良反应发生，具有较高的安全性。【结论】益气化瘀汤联合羟苯磺酸钙治疗DN气虚血瘀证患者疗效确 切，可有效下调血清VEGF、IGF-1水平，明显改善患者肾功能，显著减轻患者临床症状，且具有较高的安全性。

Objective To investigate the clinical efficacy of Yiqi Huayu Decoction（mainly composed of Astragali Radix， Dioscoreae Rhizoma， Poria， fried Euryales Semen， Ecliptae Herba， Rosae Laevigatae Fructus， charred Crataegi Fructus，Ligustri Lucidi Fructus，Salviae Miltiorrhizae Radix et Rhizoma，and Leonuri Herba） combined with Calcium Dobesilate in the treatment of diabetic nephropathy（DN）with qi deficiency and blood stasis syndrome，and to observe the effect of the therapy on vascular endothelial growth factor（VEGF）and insulin-like growth factor 1（IGF-1）. Methods Ninety patients with DN of qi deficiency and blood stasis type were randomly divided into an observation group and a control group，with 45 patients in each group. All patients received basic 广州中医药大学学报 Journal of Guangzhou University of Traditional Chinese Medicine 2024年3月第41卷第3期 March 2024，Vol. 41，No. 3 583 hypoglycemic therapy and treatment for controlling blood pressure and regulating lipid metabolism disorders. Moreover， the patients in the control group were given Calcium Dobesilate orally， and the patients in the observation group were given Yiqi Huayu Decoction combined with Calcium Dobesilate. The course of treatment lasted for 3 months. The changes of traditional Chinese medicine （TCM） syndrome scores， renal function parameters and serum VEGF and IGF-1 levels in the two groups of patients were observed before and after the treatment，and the clinical efficacy of the two groups was evaluated after treatment. Results（1）After 3 months of treatment，the total effective rate of the observation group was 91.11%（41/45），and that of the control group was 75.56%（34/45）. The intergroup comparison（tested by chi-square test）showed that the therapeutic effect of the observation group was significantly superior to that of the control group（P＜0.05）.（2）After one month and 3 months of treatment， the TCM syndrome scores of both groups were significantly lower than those before treatment（P＜0.05），and the scores after 3 months of treatment in the two groups were significantly lower than those after one month of treatment（P＜0.05）. The intergroup comparison showed that the reduction of TCM syndrome scores of the observation group was significantly superior to that of the control group after one month and 3 months of treatment（P＜0.01）.（3）After treatment， the levels of renal function parameters such as serum creatinine（Scr），blood urea nitrogen（BUN），and glomerular filtration rate（GFR）in the two groups of patients were significantly improved compared with those before treatment（P＜0.05），and the observation group’s effect on the improvement of all renal function parameters was significantly superior to that of the control group（P＜ 0.01）.（4）After treatment，the serum VEGF and IGF-1 levels in the two groups of patients were significantly lower than those before treatment（P＜0.05），and the observation group’s effect on the decrease of serum VEGF and IGF-1 levels was significantly superior to that of the control group（P＜0.01）.（5）In the course of treatment，no significant adverse reactions occurred in the two groups of patients，with a high degree of safety. Conclusion Yiqi Huayu Decoction combined with Calcium Dobesilate exerts certain therapeutic effect in treating DN patients with qi deficiency and blood stasis syndrome. The combined therapy can effectively down-regulate the serum levels of VEGF and IGF-1，significantly improve the renal function，and alleviate the clinical symptoms of the patients， with a high degree of safety.

R259.872

河北省自然科学基金项目（编号：H2020110287）；京津冀基础研究合作专项项目（编号：J200019）