目的 分析非奈利酮联合肾素-血管紧张素-醛固酮系统抑制剂（RAASi）及达格列净治疗原发性膜性肾病（PMN）患者的有效性与安全性。 方法 选取40例PMN患者，随机分为观察组（非奈利酮+RAASi+达格列净）与对照组（RAASi+达格列净），每组20例。分别于治疗第0、1、3、6个月收集两组患者24 h尿蛋白定量、内生肌酐清除率、血清肌酐、血白蛋白及血钾等临床指标，对比分析疗效及不良反应。 结果 两组24 h尿蛋白定量均较基线下降，观察组第1个月低于对照组但差异无统计学意义（P > 0.05），第3、6个月显著低于对照组（P < 0.05）；观察组第6个月血清白蛋白水平显著高于对照组（P < 0.05），第1、3个月高于对照组但差异无统计学意义（P > 0.05）。两组血清肌酐、内生肌酐清除率各时间点比较均差异无统计学意义（P > 0.05）。观察组、对照组不良反应发生率分别为40%、35%，差异无统计学意义（P > 0.05），且无严重不良反应。 结论 非奈利酮联合RAASi及达格列净可有效降低PMN患者尿蛋白水平，维持肾功能稳定，安全性良好。

Abjective　To investigate the efficacy and safety of finerenone in combination with renin-angiotensin-aldosterone system inhibitors （RAASi） and dapagliflozin in patients with primary membranous nephropathy （PMN）. Methods A total of 40 patients with PMN were randomly assigned to the treatment group （finerenone + RAASi + dapagliflozin） and the control group （RAASi + dapagliflozin）， with 20 patients in each group. Clinical indicators， such as 24-hour urinary protein， endogenous creatinine clearance rate， serum creatinine， serum albumin， and serum potassium， were collected at 0， 1， 3， and 6 months of treatment to compare the efficacy and adverse reactions between the two groups. Results The 24-hour urinary protein levels decreased in both groups when compared to the baseline. At the 1-month mark， the 24-hour urinary protein in the treatment group was lower than that in the control group， though the difference was not statistically significant （P > 0.05）. However， at 3 and 6 months， the 24-hour urinary protein in the treatment group was significantly lower than that in the control group （P < 0.05）. At 6 months， the serum albumin in the treatment group was significantly higher than that in the control group （P < 0.05）， while at 1 and 3 months， it was higher but without statistical significance （P > 0.05）. Throughout all time points， there were no significant differences in serum creatinine and endogenous creatinine clearance rate between the two groups （P > 0.05）. The incidence of adverse events was 40% in the treatment group and 35% in the control group. The difference was not statistically significant （P > 0.05）， and no serious adverse events were reported. Conclusion Finerenone， when combined with RAASi and dapagliflozin， can effectively reduce proteinuria and maintain stable renal function in patients with PMN， and it has good safety.