目的 探讨沙库巴曲缬沙坦钠联合环磷腺苷葡胺治疗左心室射血分数（LVEF）≤40%慢性心力衰竭（CHF）的临床疗效。方法 选取2020年1月—2020年12月福建医科大学附属南平市第一医院治疗的127例LVEF≤40%的慢性心力衰竭患者作为研究对象，根据治疗方法将患者分为对照组（n=63）和观察组（n=64）。对照组患者静脉滴注注射用环磷腺苷葡胺，60 mg/次，1次/d。观察组在对照组的基础上口服沙库巴曲缬沙坦钠片，50 mg/次，2次/d。两组均治疗15 d后观察疗效。比较两组治疗前后的心率变异性［全部窦性心搏RR间期的标准差（SDNN）、RR间期平均值标准差（SDANN）、相邻NN之差>50 ms的个数占总窦性心搏个数的百分比（PNN50）］、心脏功能指标［LVEF、6 min步行距离（6MWD）、左心室收缩末期容积（LVESV）、左心室舒张末期容积（LVEDV）］及血清胱抑素（CysC）、miR-451a、脑钠肽（BNP）水平。统计主要不良心脏事件（MACE）发生率。结果 治疗后，观察组治疗总有效率87.50%，显著高于对照组的71.43%（P<0.05）。治疗后，两组SDANN、SDNN、PNN50均显著升高（P<0.05），且观察组SDANN、SDNN、PNN50高于对照组（P<0.05）。治疗后，两组LVEF和6MWD均显著升高，LVESV和LVEDV显著降低（P<0.05）；且观察组心功能指标显著优于对照组（P<0.05）。治疗后，两组血清CysC、BNP水平均显著降低，miR-451a表达显著升高（P<0.05）；治疗后，观察组血清CysC、BNP水平及miR-451a表达情况显著优于对照组（P<0.05）。治疗后随访3个月，两组MACE发生率比较，差异无统计学意义。结论 环磷腺苷葡胺与沙库巴曲缬沙坦钠片联合治疗LVEF≤40%慢性心力衰竭患者疗效确切，能有效控制心率变异性，改善心功能，抑制心室重构，延缓心力衰竭进展，具有一定的临床推广价值。

Objective To investigate the effect of sacubitril valsartan sodium combined with meglumine adenosine cyclophosphate in treatment of LVEF ≤ 40% chronic heart failure. Methods A total of 127 chronic heart failure patients with LVEF ≤ 40% were selected from the First Hospital of Nanping Affiliated to Fujian Medical University from January 2020 to December 2020. The patients were divided into control group (n=63) and observation group (n=64) according to the treatment method. Patients in the control group were iv administered with Meglumine Adenosine Cyclophosphate for Injection, 60 mg/time, once daily. Patients in the observation group were po administered with Sacubitril Valsartan Sodium Tablets on the basis of control group, 50 mg/time, twice daily. Both groups were treated for 15 days and the efficacy was observed. Heart rate variability (SDNN, SDANN, PNN50) and cardiac function indexes (LVEF, 6MWD, LVESV, and LVEDV), serum CysC, miR-451a, BNP levels before and after treatment were compared. The incidence of major adverse cardiac events (MACE) was calculated. Results After treatment, the total effective rate of observation group was 87.50%, which was significantly higher than 71.43% of control group (P < 0.05). After treatment, SDANN, SDNN, and PNN50 in two groups were significantly increased (P < 0.05), and SDANN, SDNN and PNN50 in observation group were higher than those in control group (P < 0.05). After treatment, LVEF and 6 MWD in two groups were significantly increased, while LVESV and LVEDV were significantly decreased (P < 0.05). And the cardiac function index of the observation group was significantly better than that of the control group (P < 0.05). After treatment, the serum levels of CysC and BNP in two groups were significantly decreased, and the expression of miR-451a was significantly increased (P < 0.05). After treatment, the levels of serum CysC, BNP and the expression of miR-451a in the observation group were significantly better than those in the control group (P < 0.05). After 3 months of follow-up, there was no significant difference in the incidence of MACE between two groups. Conclusion The combined treatment of sacubitril valsartan sodium combined with meglumine adenosine cyclophosphate in patients with LVEF ≤ 40% chronic heart failure has an effective effect, which can effectively control heart rate variability, improve cardiac function, inhibit ventricular remodeling and delay the progression of heart failure, and has certain clinical value.

R972