目的 探讨稳心颗粒联合硝酸甘油治疗急性左心衰竭的临床效果。方法 选取2018年2月—2021年8月国药葛洲坝中心医院收治的136例急性左心衰竭患者，按随机数字表法将136例患者分成对照组和治疗组，每组各68例。对照组给予微量泵持续泵入硝酸甘油注射液，泵入速率为5μg/min。治疗组在对照组基础上开水冲服稳心颗粒，1袋/次，3次/d。两组均连续治疗7d。观察两组的临床疗效河典型表现的缓解时间。比较治疗前后两组血浆心肌损伤标志物[心肌肌钙蛋白（cTn）I、cTnT、肌酸激酶同工酶（CK-MB）、N末端B型利钠肽原（NT-proBNP）]水平、超声心动图参数[左室射血分数（LVEF）、心博量（SV）、左房容量指数（LAVI）、二尖瓣舒张期血流E峰与A峰比值（E/A）]及血清白细胞介素（IL）-1β、可溶性肿瘤生成抑制因子2（sST2）、基质金属蛋白酶9（MMP-9）和内皮素-1（ET-1）水平。结果 治疗后，治疗组总有效率是95.6%，显著高于对照组的82.4%（P<0.05）。治疗后，治疗组呼吸困难、肺部啰音、下肢水肿的缓解时间均显著短于对照组（P<0.05）。治疗后，两组血浆cTnI、cTnT、CK-MB和NT-proBNP水平均显著下降（P<0.05）；且均以治疗组降低更显著（P<0.05）。治疗后，两组LVEF、SV、E/A均显著增加，LAVI均显著降低（P<0.05）；且均以治疗组的改善更显著（P<0.05）。治疗后，两组血清IL-1β、sST2、MMP-9和ET-1水平均显著低于治疗前（P<0.05）；且治疗后，治疗组血清IL-1β、sST2、MMP-9及ET-1水平低于对照组（P<0.05）。结论 稳心颗粒联合硝酸甘油对急性左心衰竭患者具有确切的临床疗效，可安全有效且迅速地缓解患者临床表现、减轻心肌损伤、改善左心室收缩和舒张功能，并能进一步抑制患者血中IL-1β、sST2、MMP-9和ET-1水平。

Objective To investigate the clinical effect of Wenxin Granules combined with nitroglycerin in treatment of acute left heart failure. Methods A total of 136 patients with acute left heart failure admitted to Sinopharm Gezhouba Central Hospital from February 2018 to August 2021 were selected and divided into control group and treatment group according to the random number table method, with 68 cases in each group. The control group was continuously pumped with Nitroglycerin Injection at a rate of 5 μg/min. Patients in the treatment group were po administered with Wenxin Granules on the basis of the control group, 1 bag/time, 3 times daily. Both groups were treated for 7 d. The clinical efficacy of the two groups was observed and the typical remission time was observed. The levels of plasma myocardial injury markers [cardiac troponin (cTn) I, cTnT, creatine kinase isoenzyme (CK-MB), N-terminal pro-B-type natriuretic peptide (NT-proBNP)], Echocardiographic parameters [left ventricular ejection fraction (LVEF), stroke volume (SV), left atrial volume index (LAVI), mitral diastolic blood flow E-peak to A-peak ratio (E/A)] and serum Interleukin (IL)-1β, soluble tumor suppressor factor 2 (sST2), matrix metalloproteinase 9 (MMP-9) and endothelin-1 (ET-1) levels in two groups before and after treatment were compared. Results After treatment, the total effective rate of the treatment group was 95.6%, which was significantly higher than 82.4% of the control group (P< 0.05). After treatment, the remission time of dyspnea, pulmonary rales and lower limb edema in the treatment group were significantly shorter than those in the control group (P < 0.05). After treatment, the plasma levels of cTnI, cTnT, CK-MB and NT-probNP in the two groups were significantly decreased (P < 0.05). And the reduction was more significant in the treatment group (P < 0.05). After treatment, LVEF, SV and E/A were significantly increased, and LAVI was significantly decreased in both groups (P< 0.05). The improvement in treatment group was more significant (P< 0.05). After treatment, the serum levels of IL-1β, sST2, MMP-9 and ET-1 in the two groups were significantly lower than those before treatment (P< 0.05). After treatment, the serum levels of IL-1β, sST2, MMP-9 and ET-1 in the treatment group were lower than those in the control group (P < 0.05). Conclusion Wenxin Granules combined with nitroglycerin has a definite clinical effect on patients with acute left heart failure. It can safely, effectively and rapidly relieve the clinical manifestations, reduce myocardial damage, improve left ventricular systolic and diastolic function, and further inhibit the blood levels of IL-1β, sST2, MMP-9 and ET-1.

R972

三峡大学青年科学基金（KJ2019A009）