目的 探讨稳心颗粒联合依诺肝素钠治疗急性心肌梗死的临床疗效。方法 选取2022年3月—2024年3月在首都医科大学附属北京友谊医院治疗的急性心肌梗死患者106例，随机分为对照组和治疗组，每组各53例。对照组皮下注射依诺肝素钠注射液，4 000～6 000 IU/次，1～2次/d。治疗组在对照组基础上口服稳心颗粒，1袋/次，3次/d。两组疗程10 d。观察两组患者临床疗效，比较治疗前后两组患者左心室射血分数（LVEF）和血清心脏损伤标志物水平，中国冠心病患者优化抗血小板治疗（OPT-CAD）和心肌梗死多维度评估量表（MIDAS）评分，及血浆D-二聚体（D-D）、凝血酶抗凝血酶复合物（TAT）和血清白细胞介素-17（IL-17）、基质金属蛋白酶-9（MMP-9）水平。结果 治疗后，治疗组总有效率明显高于对照组（92.45% vs 77.36%，P＜0.05）。治疗后，两组LVEF水平明显高于治疗前，而血清心脏损伤标志物肌酸激酶同工酶（CK-MB）、心肌肌钙蛋白Ⅰ（cTnⅠ）和N末端B型利钠肽原（NT-proBNP）水平均低于组内治疗前（P＜0.05），且治疗组LVEF和血清心脏损伤标志物水平明显好于对照组（P＜0.05）。治疗后，两组OPT-CAD、MIDAS评分均低于组内治疗前（P＜0.05），且治疗组评分明显低于对照组（P＜0.05）。治疗后，两组患者血浆D-D、TAT和血清IL-17、MMP-9水平均低于组内治疗前（P＜0.05），且治疗组血浆D-D、TAT和血清IL-17、MMP-9水平明显低于对照组（P＜0.05）。结论 稳心颗粒联合依诺肝素钠治疗急性心肌梗死患者，可有效降低心脏损伤，调节凝血系统活性，抑制炎症反应及心肌重塑，促进患者生活质量提高和病情减轻。

Objective To investigate the clinical efficacy of Wenxin Granules combined with enoxaparin sodium in treatment of acute myocardial infarction. Methods Patients (106 cases) with acute myocardial infarction in Beijing Friendship Hospital, Capital Medical University from March 2022 to March 2024 were randomly divided into control and treatment group, and each group had 53 cases. Patients in the control group were subcutaneous injection administered with Enoxaparin Sodium Injection, 4 000 — 6 000 IU/time, 1 — 2 times daily. Patients in the treatment group were po administered with Wenxin Granules on the basis of the control group, 1 bag/time, three times daily. Patients in two groups were treated for 10 d. After treatment, the clinical evaluations were evaluated, and the LVEF, serum cardiac injury markers, OPT-CAD and MIDAS scores, the plasma D-D, TAT and serum IL-17, MMP-9 levels in two groups before and after treatment were compared. Results After treatment, the total effective rate in the treatment group was significantly higher than that in the control group (92.45% vs 77.36%, P < 0.05). After treatment, the LVEF levels in two groups were significantly higher than before treatment, while the levels of serum CK-MB, cTnⅠ, and NT-proBNP were all lower than those before treatment in the group (P < 0.05), and the LVEF and serum cardiac damage marker levels in the treatment group were significantly better than those in the control group (P < 0.05). After treatment, the OPT-CAD and MIDAS scores in two groups were lower than those before treatment (P < 0.05), and the scores in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, the levels of plasma D-D, TAT and serum IL-17 and MMP-9 in two groups were lower than those before treatment (P < 0.05), and the levels in the treatment group were significantly lower than those in the control group (P < 0.05). Conclusion The application of Wenxin Granules combined with enoxaparin sodium in the treatment of patients with acute myocardial infarction can effectively reduce heart injury, regulate the activity of coagulation system, inhibit inflammatory reaction and myocardial remodeling, and promote the improvement of patients' quality of life and disease alleviation.

R972

延安市科学技术研究发展计划项目（2017KS-17）