【目的】 基于心肌重塑和心功能标志物N端脑钠肽前体（NT-proBNP）、心型脂肪酸结合蛋白（H-FABP）水平探讨黄芪注 射液治疗慢性心力衰竭的作用。【方法】 将80例心气虚型慢性心力衰竭患者随机分为对照组和研究组，每组各40例。对照组 给予西医常规治疗，研究组在对照组的基础上给予黄芪注射液治疗，疗程为 1周。观察 2组患者治疗前后 Lee氏心衰计分、 中医证候积分、明尼苏达心力衰竭生活质量调查问卷（MLHFQ）评分及6 min步行距离的变化情况，检测2组患者治疗前后左 室射血分数（LVEF）、每搏输出量（SV）和左室舒张末期内径（LVEDD）等心功能指标以及血清NT-proBNP、H-FABP的水平变 化，并评估2组患者的临床疗效。【结果】（1）疗效方面，治疗1周后，研究组的总有效率为90.00%（36/40），对照组为62.50% （25/40），组间比较（χ2检验），研究组的疗效明显优于对照组（P＜0.01）。（2）结局指标方面，治疗后，2组患者的Lee氏心衰计 分、中医证候积分及 MLHFQ 评分均较治疗前明显下降（P＜0.01），且研究组的下降幅度均明显优于对照组（P＜0.01）。 （3）6 min步行距离方面，治疗后，2组患者的 6 min步行距离均较治疗前明显增加（P＜0.05或 P＜0.01），且研究组的增加幅 度明显优于对照组（P＜0.05）。（4）实验室指标方面，治疗后，2组患者的血清NT-proBNP、H-FABP水平均较治疗前明显下降 （P＜0.01），且研究组的下降幅度均明显优于对照组（P＜0.01）。（5）心功能指标方面，治疗后，2组患者的 LVEF、SV水平均 较治疗前明显升高（P＜0.01），且研究组的升高幅度均明显优于对照组（P＜0.01）；而2组患者的LVEDD治疗前后及治疗后组 间比较，差异均无统计学意义（P＞0.05）。【结论】 在西医常规治疗基础上联合黄芪注射液治疗心气虚型慢性心力衰竭患者 疗效确切，能有效缓解患者临床症状，改善患者心功能，提高患者生活质量。

Objective To investigate the effect of Astragali Radix Injection on chronic heart failure（CHF）from the Perspective of myocardial remodeling and the levels of cardiac function markers of N-terminal pro-brain natriuretic peptide（NT-ProBNP）and heart-type fatty acid binding protein（H-FABP）. Methods A total of 80 CHF patients with heart qi deficiency syndrome were randomly divided into control group and study group，with 40 cases in each group. The control group was treated with routine western medicine，and the study group was treated with Astragali Radix Injection on the basis of treatment for the control group. The course of treatment covered one week. The changes of Lee’s heart failure score，traditional Chinese medicine（TCM）syndrome score，Minnesota Living with Heart Failure Questionnaire（MLHFQ）score and 6-minute walking distance（6MWD）in the two groups were observed before and after treatment. Moreover，the changes of cardiac function indicators such as left ventricular ejection fraction（LVEF），stroke volume（SV）and left ventricular end-diastolic diameter（LVEDD）as well as the serum levels of cardiac function markers of NT-proBNP and H-FABP in the two groups before and after treatment were detected. After treatment，the clinical efficacy of the two groups was evaluated. Results（1）After one week of treatment，the total effective rate of the study group was 90.00%（36/40），and that of the control group was 62.50%（25/40）. The intergroup comparison（tested by chi-square test）showed that the efficacy of the study group was significantly superior to that of the control group（P＜0.01）.（2）After treatment，the outcomes of Lee’s heart failure score，TCM syndrome score and MLHFQ score of the two groups were significantly lower than those before treatment（P＜0.01），and the decrease of the scores in the study group was significantly superior to that in the control group（P＜0.01）.（3）After treatment，the 6MWD of the two groups was significantly increased compared with that before treatment（P＜0.05 or P＜0.01），and the increase of 6MWD in the study group was significantly superior to that in the control group（P＜0.05）.（4）After treatment，the serum levels of laboratory indicators of NT-proBNP and H-FABP in the two groups were significantly lower than those before treatment（P＜ 0.01），and the decrease in the study group was significantly superior to that in the control group（P＜0.01）.（5）After treatment，the levels of cardiac function indicators of LVEF and SV in the two groups were significantly increased compared with those before treatment（P＜0.01），and the increase in the study group was significantly superior to that in the control group（P＜0.01）. However，LVEDD in the two groups after treatment did not differ from that before treatment，no significant difference of LVEDD was shown between the two groups after treatment，either （P＞0.05）. Conclusion On the basis of conventional western medicine treatment， the application of Astragali Radix Injection exerts certain curative effect for the treatment of CHF of heart qi deficiency type. The combined therapy is effective on alleviating the clinical symptoms of patients and improving the heart function and the quality of life of the patients.

R259.416

国家自然科学基金资助项目（编号：81804045）