目的 研究沙库巴曲缬沙坦钠片联合盐酸曲美他嗪片治疗缺血性心肌病的疗效以及对血清内皮素-1（ET-1）、N末端钠尿肽前体（NT-proBNP）水平的影响。方法 选取2019年8月—2020年12月邢台市第三医院收治的148例缺血性心肌病患者为研究对象，根据治疗方法将患者分为对照组和观察组，每组各74例。对照组服用盐酸曲美他嗪片，1片/次，3次/d。观察组患者在对照组基础上服用沙库巴曲缬沙坦钠片，初始剂量为50 mg，2次/d，若患者可耐受则提高至200 mg，2次/d。两组患者均治疗4周。观察两组患者的临床疗效，同时比较两组治疗前后的心功能指标、血清ET-1、NT-pro BNP水平、6分钟步行距离（6 MWT）、日常生活活动能力（ADL）评分。结果 治疗后，观察组总有效率为93.24%，显著高于对照组的82.43%，差异有统计学意义（P<0.05）。治疗后，左室射血分数（LVEF）明显增加，左心室收缩末期容积（LVESV）、左心室舒张末期容积（LVEDV）明显降低（P<0.05），且观察组心功能指标改善情况显著优于对照组（P<0.05）。治疗后，血清ET-1、NT-pro BNP水平均明显降低（P<0.05），其中观察组血清ET-1、NT-pro BNP水平显著低于对照组（P<0.05）。治疗后，ADL评分和6 MWT均明显增加（P<0.05），且观察组ADL评分和6 MWT显著高于对照组（P<0.05）。结论 沙库巴曲缬沙坦钠片联合曲美他嗪治疗对缺血性心肌病疗效显著，可有效降低血清ET-1、NT-pro BNP水平，降低心肌损伤，利于疾病恢复，提高患者日常生活能力，值得临床推广。

Objective To study the curative effect of Sacubitril Valsartan Sodium Tablets combined with Trimetazidine Dihydrochloride Tablets in treatment of ischemic cardiomyopathy and its effect on serum ET-1 and NT-proBNP. Methods A total of 148 patients with ischemic cardiomyopathy admitted to the Xingtai Third Hospital from August 2019 to December 2020 were selected as the research subjects. According to the treatment methods, the patients were divided into control group and observation group, with 74 patients in each group. Patients in the control group were po administered with Trimetazidine Dihydrochloride Tablets, 1 table/time, three times daily. Patients in the observation group were po administered with Sacubitril Valsartan Sodium Tablets on the basis of control group, the initial dose was 50 mg, twice daily, and the dose was increased to 200 mg twice daily if patients could tolerate it. Patients in both groups were treated for 4 weeks. Clinical efficacy of two groups was observed. Cardiac function indexes, serum ET-1, NT-Pro BNP levels, 6-minute walking test (6 MWT), and activity of daily living (ADL) before and after treatment were compared between two groups. Results After treatment, the total effective rate of the observation group was 93.24%, significantly higher than 82.43% of the control group, and the difference was statistically significant (P < 0.05). After treatment, LVEF was significantly increased, LVESV and LVEDV were significantly decreased (P < 0.05), and the improvement of heart function indexes in the observation group was significantly better than that in the control group (P < 0.05). After treatment, serum ET-1 and NT-pro BNP levels were significantly decreased (P < 0.05), and the serum ET-1 and NT-pro BNP levels in the observation group were significantly lower than those in the control group (P < 0.05). After treatment, ADL score and 6 MWT were significantly increased (P < 0.05), and the ADL score and 6 MWT in observation group were significantly higher than those in control group (P < 0.05). Conclusion Sacubitril Valsartan Sodium Tablets combined with trimetazidine has a significant effect on ischemic cardiomyopathy, which can effectively reduce serum ET-1 and NT-Pro BNP levels, reduce myocardial injury, benefit disease recovery and improve patients' ability of daily life, and is worthy of clinical promotion.

R972

邢台市重点研发计划项目（2020ZC268）