目的 观察麝香保心丸联合托伐普坦治疗老年射血分数降低性心力衰竭的临床疗效及其对心肌损伤、炎性因子的影响。方法 选取2022年4月—2024年5月周口市中心医院收治的100例老年射血分数降低性心力衰竭患者，按照随机数字法分为对照组和治疗组，每组各50例。对照组口服托伐普坦片，15 mg/次，1次/d。治疗组在对照组的治疗基础上口服麝香保心丸，45 mg/次，3次/d。两组持续用药8周。观察两组的临床疗效，比较两组治疗前后中医证候积分、6 min步行试验距离（6MWD）、明尼苏达心力衰竭生活质量调查表（MLHFQ）评分、心功能指标、心肌损伤因子和血清炎症因子水平的变化情况。结果 治疗后，治疗组总有效率是96.00%，显著高于对照组的82.00%（P＜0.05）。治疗后，两组气短乏力积分、心悸积分、身寒肢冷积分、动则气喘积分均较治疗前显著降低（P＜0.05）；治疗后，治疗组中医症候积分低于对照组（P＜0.05）。治疗后，两组MLHFQ（情绪领域、身体邻域、其他邻域）评分较同组治疗前降低，而6MWD显著升高（P＜0.05）；治疗后，治疗组MLHFQ评分低于对照组，6MWD高于对照组（P＜0.05）。治疗后，两组患者左心室收缩末期内径（LVESD）、左心室舒张末期内径（LVEDD）较同组治疗前显著降低，左心室射血分数（LVEF）升高（P＜0.05）；治疗后，治疗组LVESD、LVEDD低于对照组，LVEF高于对照组（P＜0.05）。治疗后，两组高敏肌钙蛋白T（hs-cTnT）、氨基末端脑利钠肽前体（NT-proBNP）、心肌型脂肪酸结合蛋白（H-FABP）水平均显著降低（P＜0.05）；治疗后，治疗组hs-cTnT、NT-proBNP、H-FABP低于对照组（P＜0.05）。治疗后，两组转化生长因子-β1（TGF-β1）、生长转化因子-15（GDF-15）、可溶性生长刺激表达基因2蛋白（sST2）、白细胞介素-6（IL-6）水平显著降低（P＜0.05）；治疗后，治疗组TGF-β1、GDF-15、sST2、IL-6水平低于对照组（P＜0.05）。结论 麝香保心丸联合托伐普坦治疗老年射血分数降低性心力衰竭可发挥协同作用，能明显改善患者症状，缓解心肌受损程度，减弱机体炎症反应，值得借鉴与推广。

Objective To observe the efficacy of Shexiang Baoxin Pills combined with tolvaptan in treatment of senile heart failure with reduced ejection fraction and its effect on myocardial injury and inflammatory factors. Methods A total of 100 elderly patients with reduced ejection fraction heart failure admitted to Zhoukou Central Hospital from April 2022 to May 2024 were selected and divided into control group and treatment group according to random number method, with 50 cases in each group. Patients in control group were po administered with Tolvaptan Tablets, 15 mg/time, once daily. Patients in treatment group were po administered with Shexiang Baoxin Pills on the basis of the control group, 45 mg/time, three times daily. Both groups were treated for 8 weeks. The clinical effects of two groups were observed, and the changes of TCM syndrome scores, 6-min walking distance (6MWD), Minnesota Heart Failure Quality of Life Questionnaire (MLHFQ) scores, cardiac function indexes, myocardial injury factors, and serum inflammatory factors before and after treatment were compared between two groups. Results After treatment, the total effective rate of treatment group was 96.00%, which was significantly higher than that of control group (82.00%, P < 0.05). After treatment, the scores of shortness of breath, palpitation, cold body and limb, and asthma were significantly decreased in both groups compared with before treatment (P< 0.05). After treatment, the scores of TCM symptoms in treatment group were lower than those in control group (P < 0.05). After treatment, MLHFQ (emotional domain, body neighborhood, other neighborhood) scores in two groups were lower than before treatment, but 6MWD was significantly increased (P< 0.05). After treatment, MLHFQ score in treatment group was lower than that in control group, and 6MWD score was higher than that in control group (P< 0.05). After treatment, left ventricular end-systolic diameter (LVESD) and left ventricular end-diastolic diameter (LVEDD) in two groups were significantly lower than before treatment, but left ventricular ejection fraction (LVEF) was increased (P < 0.05). After treatment, LVESD and LVEDD in treatment group were lower than those in control group, but LVEF was higher than control group (P < 0.05). After treatment, the levels of high-sensitivity troponin T (hs-cTnT), amino terminal brain natriuretic peptide precursor (NT-proBNP) and cardiac fatty acid binding protein (H-FABP) were significantly decreased in both groups (P < 0.05). After treatment, hs-cTnT, NT-proBNP and H-FABP in treatment group were lower than those in control group (P < 0.05). After treatment, the levels of transforming growth factor-β1 (TGF-β1), growth transforming factor-15 (GDF-15), soluble growth stimulation expression gene 2 protein (sST2) and interleukin-6 (IL-6) in two groups were significantly decreased (P < 0.05). After treatment, the levels of TGF-β1, GDF-15, sST2 and IL-6 in treatment group were lower than those in control group (P < 0.05). Conclusion Shexiang Baoxin Pills combined with tolvaptan can play a synergistic role in treatment of senile heart failure with reduced ejection fraction, and can obviously improve the symptoms of patients, relieve the degree of myocardial damage, and weaken the inflammatory response of the body, which is worth learning and promoting.

R972

河南省卫生健康科研项目（LHGJ20241001）