目的 探討沙庫(kù)巴曲纈沙坦鈉聯(lián)合環(huán)磷腺苷葡胺治療左心室射血分?jǐn)?shù)（LVEF）≤40%慢性心力衰竭（CHF）的臨床療效。方法 選取2020年1月—2020年12月福建醫(yī)科大學(xué)附屬南平市第一醫(yī)院治療的127例LVEF≤40%的慢性心力衰竭患者作為研究對(duì)象，根據(jù)治療方法將患者分為對(duì)照組（n=63）和觀察組（n=64）。對(duì)照組患者靜脈滴注注射用環(huán)磷腺苷葡胺，60 mg/次，1次/d。觀察組在對(duì)照組的基礎(chǔ)上口服沙庫(kù)巴曲纈沙坦鈉片，50 mg/次，2次/d。兩組均治療15 d后觀察療效。比較兩組治療前后的心率變異性［全部竇性心搏RR間期的標(biāo)準(zhǔn)差（SDNN）、RR間期平均值標(biāo)準(zhǔn)差（SDANN）、相鄰NN之差>50 ms的個(gè)數(shù)占總竇性心搏個(gè)數(shù)的百分比（PNN50）］、心臟功能指標(biāo)［LVEF、6 min步行距離（6MWD）、左心室收縮末期容積（LVESV）、左心室舒張末期容積（LVEDV）］及血清胱抑素（CysC）、miR-451a、腦鈉肽（BNP）水平。統(tǒng)計(jì)主要不良心臟事件（MACE）發(fā)生率。結(jié)果 治療后，觀察組治療總有效率87.50%，顯著高于對(duì)照組的71.43%（P<0.05）。治療后，兩組SDANN、SDNN、PNN50均顯著升高（P<0.05），且觀察組SDANN、SDNN、PNN50高于對(duì)照組（P<0.05）。治療后，兩組LVEF和6MWD均顯著升高，LVESV和LVEDV顯著降低（P<0.05）；且觀察組心功能指標(biāo)顯著優(yōu)于對(duì)照組（P<0.05）。治療后，兩組血清CysC、BNP水平均顯著降低，miR-451a表達(dá)顯著升高（P<0.05）；治療后，觀察組血清CysC、BNP水平及miR-451a表達(dá)情況顯著優(yōu)于對(duì)照組（P<0.05）。治療后隨訪3個(gè)月，兩組MACE發(fā)生率比較，差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論 環(huán)磷腺苷葡胺與沙庫(kù)巴曲纈沙坦鈉片聯(lián)合治療LVEF≤40%慢性心力衰竭患者療效確切，能有效控制心率變異性，改善心功能，抑制心室重構(gòu)，延緩心力衰竭進(jìn)展，具有一定的臨床推廣價(jià)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