目的 探讨振源胶囊联合沙库巴曲缬沙坦钠片治疗慢性心力衰竭的临床疗效。方法 选取2021年1月—2022年1月在邯郸市中心医院诊治的106例慢性心力衰竭患者，按随机数字表法分为对照组（53例）和治疗组（53例）。对照组口服沙库巴曲缬沙坦钠片，初始剂量为50～100 mg/次，2次/d，根据患者血压耐受性逐步增加剂量，直至200 mg/次，2次/d，并维持。治疗组在对照组基础上口服振源胶囊，2粒/次，3次/d。两组患者均治疗16周。观察两组患者临床疗效，比较治疗前后两组患者超声心动图指标左心室射血分数（LVEF）、左室舒张末期内径（LVEDd）、左心室后壁厚度（LVPWT）、室间隔厚度（IVST）和校正体表面积后计算左心室心肌质量指数（LVMI）水平，运动能力指标最大运动功率（W_max）、最大运动时间（t_max）、峰值氧耗量（Peak VO₂）和无氧阈氧耗量（VO₂AT）水平，实验室检测指标N末端B型利钠肽原（NT-proBNP）、高迁移率族蛋白1（HMGB1）、可溶性生长刺激表达基因2蛋白（sST2）、半乳糖凝集素-3（Gal-3）和中性粒细胞/淋巴细胞比值（NLR）水平。结果 治疗后，治疗组总有效率为96.23%，对照组总有效率为84.91%，两组比较差异具有统计学意义（P<0.05）。治疗后，两组患者LVEF水平较治疗前均显著提高，而LVEDd、LVPWT、IVST、LVMI水平显著下降（P<0.05），且治疗组患者超声心动图指标水平比对照组改善更明显（P<0.05）。治疗后，两组患者W_max、t_max、Peak VO₂、VO₂AT指标水平较治疗前均显著提高（P<0.05），且治疗组患者运动能力指标水平比对照组提高更明显（P<0.05）。治疗后，两组患者NT-proBNP、NLR、HMGB1、sST2、Gal-3水平较治疗前均显著下降（P<0.05），且治疗组患者比对照组下降更明显（P<0.05）。结论 振源胶囊联合沙库巴曲缬沙坦钠治疗慢性心力衰竭具有良好临床疗效，可有效改善患者心功能，增加射血分数，提高运动能力，减轻炎性反应，改善心室重构，且安全性较高。

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

河北省中医药管理局科研计划项目（2021182）