目的 探究通脈養(yǎng)心丸與沙庫巴曲纈沙坦鈉協(xié)同治療慢性心力衰竭患者的臨床療效與安全性。方法 納入2022年6月—2023年12月于武漢科技大學附屬武漢市武昌醫(yī)院收治的85例慢性心力衰竭患者，基于治療方案差異分配至對照組（n=42）與治療組（n=43）。對照組給藥方案為沙庫巴曲纈沙坦鈉片口服給藥，起始劑量50 mg/次，2次/d，，每兩周實施劑量倍增調整，最終維持劑量200 mg/次，2次/d。治療組在對照組治療基礎上加用通脈養(yǎng)心丸，40丸/次，2次/d。兩組患者均實施為期6周的規(guī)范化治療干預。觀察兩組患者臨床療效，比較治療前后兩組患者Lee氏心衰評分和健康調查簡表（SF-36）評分，心功能指標左心室舒張末期內徑（LVEDD）、左室后壁厚度（LVPW）和左室后壁厚度（LVPW），及血清細胞因子胱抑素C（Cys C）、可溶性髓系細胞表達觸發(fā)受體-1（sTREM-1）和生長分化因子11（GDF11）水平。結果 治療后，對照組與治療組總有效率分別為80.95%、95.35%，組間對比有統(tǒng)計學差異（P＜0.05）。治療后，兩組患者Lee氏心衰評分顯著下降，SF-36評分顯著提升（P＜0.05）；與對照組比較，治療組改善幅度具有顯著優(yōu)勢（P＜0.05）。心臟彩超參數(shù)顯示，兩組患者LVEDD與LVPW均顯著縮減，LVEF水平同步提升（P＜0.05）；治療組LVEDD、LVPW、LVEF改善優(yōu)于對照組（P＜0.05）。血清學檢測結果顯示，兩組患者血清Cys C、sTREM-1及GDF11水平顯著降低（P＜0.05）；治療組細胞因子水平下降幅度顯著優(yōu)于對照組（P＜0.05）。結論 通脈養(yǎng)心丸聯(lián)合沙庫巴曲纈沙坦鈉治療慢性心力衰竭具有協(xié)同增效作用，同時還可改善患者心功能和生活質量，同步促進血清標志物水平復常，在提升療效的同時未增加安全風險。

Objective To explore the therapeutic effect of Tongmai Yangxin Pills combined with sacubitril valsartan sodium in treatment of chronic heart failure. Methods Patients (85 cases) with chronic heart failure in Wuhan Wuchang Hospital Affiliated to Wuhan University of Science and Technology from June 2022 to December 2023 were divided into control (42 cases) and treatment (43 cases) group based on different treatments. Patients in the control group were po administered with Sacubitril Valsartan Sodium Tablets, the starting dose was 50 mg/time, twice daily, and the dose doubled once after 2 weeks, the final maintenance dose was 200 mg/time, twice daily. Patients in the treatment group were po administered with Tongmai Yangxin Pills on the basis of the control group, 40 pills/time, twice daily. Patients in two groups were treated for 6 weeks. After treatment, the clinical evaluations were evaluated, and the Lee's heart failure score and SF-36 score, the cardiac function indexes LVEDD, LVPW, and LVEF, and the levels of serum cytokine Cys C, sTREM-1, and GDF11 in two groups before and after treatment were compared. Results After treatment, the total effective rate of control group and treatment group was 80.95% and 95.35%, respectively, with statistical difference between the groups (P < 0.05). After treatment, Lee's heart failure score decreased significantly and SF-36 score increased significantly (P < 0.05). The improvement of treatment group was significantly superior (P < 0.05). Cardiac color ultrasound parameters showed that LVEDD and LVPW were significantly reduced in both groups, but LVEF levels were increased simultaneously (P < 0.05). The improvement of indexes in treatment group was significantly higher than that in control group (P < 0.05). Serological test results showed that the levels of serum Cys C, sTREM-1 and GDF11 in 2 groups were significantly decreased (P < 0.05). The decrease of all indexes in treatment group was significantly higher than that in control group (P < 0.05). Conclusion Tongmai Yangxin Pills combined with sakubatril valsartan sodium has a synergistic effect in the treatment of chronic heart failure, and can also improve the cardiac function and quality of life of patients, and promote the level of serum markers to normalize simultaneously, which improves the efficacy without increasing the safety risk.

R972

湖北省自然科學基金資助項目（2022CFC025）