目的 探究心通顆粒聯(lián)合依洛尤單抗輔助治療慢性心力衰竭（CHF）合并高脂血癥的療效及對(duì)機(jī)體炎癥介質(zhì)的影響。方法 回顧性選取2019年1月—2021年6月山西省心血管病醫(yī)院收治的150例CHF合并高脂血癥患者作為研究對(duì)象，根據(jù)治療方案分為對(duì)照組和試驗(yàn)組，每組各75例。對(duì)照組在常規(guī)化學(xué)藥抗CHF及調(diào)脂治療基礎(chǔ)上加用依洛尤單抗注射液治療，每2周sc 140 mg。試驗(yàn)組在對(duì)照組基礎(chǔ)上加用心通顆粒，每次10.6 g，每天3次，口服。兩組均治療8周。比較兩組療效，分別于治療前后測定兩組患者心功能［心輸出量（CO）、左室舒張末期內(nèi)徑（LVEDD）、左心室射血分?jǐn)?shù)（LVEF）、左室收縮末期內(nèi)徑（LVESD）］、血脂［三酰甘油（TG）、低密度脂蛋白-膽固醇（LDL-C）、總膽固醇（TC）、高密度脂蛋白-膽固醇（HDL-C）］水平及炎癥介質(zhì)［白細(xì)胞介素-6（IL-6）、腫瘤壞死因子-α（TNF-α）、C反應(yīng)蛋白（CRP）、基質(zhì)金屬蛋白酶-9（MMP-9）］水平，記錄治療后隨訪6個(gè)月兩組不良心血管事件（MACE）發(fā)生情況，記錄治療期間兩組不良反應(yīng)發(fā)生情況。結(jié)果 治療8周后，試驗(yàn)組總有效率（93.33%）顯著高于對(duì)照組（81.33%、P＜0.05）。治療前兩組患者CO、LVEDD、LVEF、LVESD水平比較，差異無統(tǒng)計(jì)學(xué)意義（P＞0.05），治療后兩組患者CO、LVEDD、LVEF、LVESD水平均較治療前改善（P＜0.05），且試驗(yàn)組CO、LVEF較對(duì)照組顯著升高（P＜0.05），LVEDD、LVESD水平較對(duì)照組顯著降低（P＜0.05）。治療前兩組患者TG、LDL-C、TC、HDL-C水平比較，差異無統(tǒng)計(jì)學(xué)意義（P＞0.05），治療后兩組TG、LDL-C、TC、HDL-C水平均較治療前顯著改善（P＜0.05），且試驗(yàn)組TG、LDL-C、TC均顯著低于對(duì)照組（P＜0.05），HDL-C顯著高于對(duì)照組（P＜0.05）。治療前兩組患者血清IL-6、TNF-α、CRP、MMP-9水平比較，差異無統(tǒng)計(jì)學(xué)意義（P＞0.05），治療后兩組患者血清IL-6、TNF-α、CRP、MMP-9水平均較治療前顯著降低（P＜0.05），且試驗(yàn)組較對(duì)照組降低更顯著（P＜0.05）。兩組MACE、不良反應(yīng)發(fā)生率比較，差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）。結(jié)論 心通顆粒聯(lián)合依洛尤單抗輔助治療CHF合并高脂血癥患者效果顯著，可有效提高心功能，降低血脂水平，減輕機(jī)體炎癥，且安全性高。

Objective To investigate the efficacy of Xintong Granule combined with evolocumab in adjuvant treatment of chronic heart failure (CHF) complicated with hyperlipidemia and its effect on inflammatory mediators. Methods A total of 150 patients with CHF complicated with hyperlipidemia treated in Shanxi Provincial Cardiovascular Hospital from January 2019 to June 2021 were retrospectively selected as the research objects. According to the treatment plan, they were divided into control group and experimental group, with 75 cases in each group. Patients in control group were treated with Evolocumab Injection on the basis of conventional chemical anti CHF and lipid-lowering therapy, sc 140 mg every two weeks. On the basis of the control group, patients in experimental group were added Xinxintong Granules, 10.6 g each time, three times a day, orally. Both groups were treated for eight weeks. The curative effects of two groups were compared. The levels of cardiac function[cardiac output (CO), left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), left ventricular end systolic diameter (LVESD)], blood lipids[triacylglycerol (TG), low density lipoprotein cholesterol (LDL-C), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C)] and inflammatory mediators[interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) and matrix metalloproteinase-9 (MMP-9)] were measured before and after treatment. Incidence of adverse cardiovascular events (MACE) in two groups was recorded during the six-month follow-up after treatment. The adverse reactions of two groups during treatment were recorded. Results After eight weeks of treatment, the total effective rate of experimental group (93.33%) was significantly higher than that of control group (81.33%, P < 0.05). There was no significant difference in levels of CO, LVEDD, LVEF and LVESD between two groups before treatment (P > 0.05). After treatment, the levels of CO, LVEDD, LVEF and LVESD in two groups were improved compared with those before treatment (P < 0.05), and the levels of CO and LVEF in experimental group were significantly higher than those in control group (P < 0.05), and the levels of LVEDD and LVESD in experimental group were significantly lower than those in control group (P < 0.05). There was no significant difference in levels of TG, LDL-C, TC and HDL-C between two groups before treatment (P > 0.05). After treatment, the levels of TG, LDL-C, TC and HDL-C in two groups were significantly improved compared with those before treatment (P < 0.05), and TG, LDL-C and TC in experimental group were significantly lower than those in control group (P < 0.05), and HDL-C was significantly higher than those in control group (P < 0.05). There was no significant difference in the levels of serum IL-6, TNF- α, CRP and MMP-9 in two groups before treatment (P > 0.05). After treatment, the levels of serum IL-6, TNF-α, CRP and MMP-9 in two groups were significantly lower than those before treatment (P < 0.05), and the levels of serum IL-6, TNF-α, CRP and MMP-9 in experimental group were significantly lower than those in control group (P < 0.05). There was no significant difference in the incidence of MACE and adverse reactions between two groups (P > 0.05). Conclusion Xintong Granule combined with evolocumab is effective in adjuvant treatment of CHF patients with hyperlipidemia, which can effectively improve cardiac function, reduce blood lipid level, reduce body inflammation, and has high safety.

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