目的 探討振源膠囊聯(lián)合沙庫巴曲纈沙坦鈉片治療慢性心力衰竭的臨床療效。方法 選取2021年1月—2022年1月在邯鄲市中心醫(yī)院診治的106例慢性心力衰竭患者，按隨機數(shù)字表法分為對照組（53例）和治療組（53例）。對照組口服沙庫巴曲纈沙坦鈉片，初始劑量為50～100 mg/次，2次/d，根據(jù)患者血壓耐受性逐步增加劑量，直至200 mg/次，2次/d，并維持。治療組在對照組基礎(chǔ)上口服振源膠囊，2粒/次，3次/d。兩組患者均治療16周。觀察兩組患者臨床療效，比較治療前后兩組患者超聲心動圖指標(biāo)左心室射血分?jǐn)?shù)（LVEF）、左室舒張末期內(nèi)徑（LVEDd）、左心室后壁厚度（LVPWT）、室間隔厚度（IVST）和校正體表面積后計算左心室心肌質(zhì)量指數(shù)（LVMI）水平，運動能力指標(biāo)最大運動功率（W_max）、最大運動時間（t_max）、峰值氧耗量（Peak VO₂）和無氧閾氧耗量（VO₂AT）水平，實驗室檢測指標(biāo)N末端B型利鈉肽原（NT-proBNP）、高遷移率族蛋白1（HMGB1）、可溶性生長刺激表達(dá)基因2蛋白（sST2）、半乳糖凝集素-3（Gal-3）和中性粒細(xì)胞/淋巴細(xì)胞比值（NLR）水平。結(jié)果 治療后，治療組總有效率為96.23%，對照組總有效率為84.91%，兩組比較差異具有統(tǒng)計學(xué)意義（P<0.05）。治療后，兩組患者LVEF水平較治療前均顯著提高，而LVEDd、LVPWT、IVST、LVMI水平顯著下降（P<0.05），且治療組患者超聲心動圖指標(biāo)水平比對照組改善更明顯（P<0.05）。治療后，兩組患者W_max、t_max、Peak VO₂、VO₂AT指標(biāo)水平較治療前均顯著提高（P<0.05），且治療組患者運動能力指標(biāo)水平比對照組提高更明顯（P<0.05）。治療后，兩組患者NT-proBNP、NLR、HMGB1、sST2、Gal-3水平較治療前均顯著下降（P<0.05），且治療組患者比對照組下降更明顯（P<0.05）。結(jié)論 振源膠囊聯(lián)合沙庫巴曲纈沙坦鈉治療慢性心力衰竭具有良好臨床療效，可有效改善患者心功能，增加射血分?jǐn)?shù)，提高運動能力，減輕炎性反應(yīng)，改善心室重構(gòu)，且安全性較高。

Objective To explore the clinical effect of Zhenyuan Capsules combined with sacubitril valsartan in treatment of chronic heart failure. Methods Patients (106 cases) with chronic heart failure in Handan Central Hospital from January 2021 to January 2022 were divided into control (53 cases) and treatment (53 cases) group according to the random number table method. Patients in the control group was po administered with Sacubitril Valsartan Sodium Tablets, 50-100 mg/time was the initial dose, twice daily, gradually increased the dose up to 200 mg/time according to the patient's blood pressure tolerance, twice daily. Patients in the treatment group were po administered with Zhenyuan Capsules on the basis of the control group, 2 grains/time, three times daily. Patients in two groups were treated for 16 weeks. After treatment, the clinical evaluation was evaluated, and the echocardiographic indexes of LVEF, LVEDd, LVPWT, IVST and LVMI, sports ability indexes of W_max, T_max, Peak VO₂ and VO₂AT, the indicators of laboratory testing of NT-proBNP, NLR, HMGB1, sST2 and Gal-3 in two groups before and after treatment were compared. Results After treatment, the clinical effective rate of the treatment group was 96.23%, while that of the control group was 84.91%, and the difference between two groups was statistically significant (P < 0.05). After treatment, the levels of LVEF in two groups were significantly higher than those before treatment, while the levels of LVEDd, LVPWT, IVST, and LVMI were significantly decreased (P < 0.05), and the level of echocardiographic indexes in the treatment group were significantly better than those in the control group (P< 0.05). After treatment, the levels of W_max, T_max, Peak VO₂ and VO₂AT in two groups were significantly higher than those before treatment (P < 0.05), and the levels of exercise ability in the treatment group were significantly higher than those in the control group (P < 0.05). After treatment, the levels of NT-proBNP, NLR, HMGB1, sST2, and Gal-3 in two groups were significantly lower than those before treatment (P < 0.05), and the levels in the treatment group were more significantly lower than those in the control group (P< 0.05). Conclusions Zhenyuan Capsules combined with sacubitril valsartan has good clinical effect in treatment of chronic heart failure, which can effectively improve patients' cardiac function, increase ejection fraction, improve exercise ability, reduce inflammatory reaction, improve ventricular remodeling, and has high safety.

R972

河北省中醫(yī)藥管理局科研計劃項目（2021182）