目的 觀察麝香保心丸聯(lián)合托伐普坦治療老年射血分?jǐn)?shù)降低性心力衰竭的臨床療效及其對心肌損傷、炎性因子的影響。方法 選取2022年4月—2024年5月周口市中心醫(yī)院收治的100例老年射血分?jǐn)?shù)降低性心力衰竭患者，按照隨機(jī)數(shù)字法分為對照組和治療組，每組各50例。對照組口服托伐普坦片，15 mg/次，1次/d。治療組在對照組的治療基礎(chǔ)上口服麝香保心丸，45 mg/次，3次/d。兩組持續(xù)用藥8周。觀察兩組的臨床療效，比較兩組治療前后中醫(yī)證候積分、6 min步行試驗(yàn)距離（6MWD）、明尼蘇達(dá)心力衰竭生活質(zhì)量調(diào)查表（MLHFQ）評分、心功能指標(biāo)、心肌損傷因子和血清炎癥因子水平的變化情況。結(jié)果 治療后，治療組總有效率是96.00%，顯著高于對照組的82.00%（P＜0.05）。治療后，兩組氣短乏力積分、心悸積分、身寒肢冷積分、動則氣喘積分均較治療前顯著降低（P＜0.05）；治療后，治療組中醫(yī)癥候積分低于對照組（P＜0.05）。治療后，兩組MLHFQ（情緒領(lǐng)域、身體鄰域、其他鄰域）評分較同組治療前降低，而6MWD顯著升高（P＜0.05）；治療后，治療組MLHFQ評分低于對照組，6MWD高于對照組（P＜0.05）。治療后，兩組患者左心室收縮末期內(nèi)徑（LVESD）、左心室舒張末期內(nèi)徑（LVEDD）較同組治療前顯著降低，左心室射血分?jǐn)?shù)（LVEF）升高（P＜0.05）；治療后，治療組LVESD、LVEDD低于對照組，LVEF高于對照組（P＜0.05）。治療后，兩組高敏肌鈣蛋白T（hs-cTnT）、氨基末端腦利鈉肽前體（NT-proBNP）、心肌型脂肪酸結(jié)合蛋白（H-FABP）水平均顯著降低（P＜0.05）；治療后，治療組hs-cTnT、NT-proBNP、H-FABP低于對照組（P＜0.05）。治療后，兩組轉(zhuǎn)化生長因子-β1（TGF-β1）、生長轉(zhuǎn)化因子-15（GDF-15）、可溶性生長刺激表達(dá)基因2蛋白（sST2）、白細(xì)胞介素-6（IL-6）水平顯著降低（P＜0.05）；治療后，治療組TGF-β1、GDF-15、sST2、IL-6水平低于對照組（P＜0.05）。結(jié)論 麝香保心丸聯(lián)合托伐普坦治療老年射血分?jǐn)?shù)降低性心力衰竭可發(fā)揮協(xié)同作用，能明顯改善患者癥狀，緩解心肌受損程度，減弱機(jī)體炎癥反應(yīng)，值得借鑒與推廣。

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

河南省衛(wèi)生健康科研項(xiàng)目（LHGJ20241001）