【目的】 探究益气活血通脉汤（补阳还五汤为主化裁）联合西药对左心疾病相关性肺动脉高压（PH-LHD）气虚血瘀证患者 的疗效及内皮功能的影响。【方法】 将2022年3月～2023年12月在商洛市中心医院接受治疗的80例PH-LHD气虚血瘀证患者 随机分为研究组和对照组，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加用益气活血通脉汤治疗， 疗程为3周。观察2组患者干预前后中医证候积分、肺循环指标[平均肺动脉压（mPAP）和肺毛细血管楔压（PCWP）]、心肺运 动试验（CPET）指标[峰值心率、峰值收缩压、峰值舒张压、峰值氧耗量（VO2max）、峰值氧脉搏]、血管内皮指标[血清一氧化 氮（NO）和内皮素 1（ET-1）]及生活质量的变化情况，比较 2 组患者的临床疗效和不良反应情况。【结果】（1）疗效方面，干预 3周后，研究组的总有效率为90.00%（36/40），对照组为72.50%（29/40），组间比较（χ²检验），研究组的疗效明显优于对照组 （P < 0.05）。（2）中医证候积分方面，干预后，2组患者的主症积分、次症积分及总积分均较干预前降低（P < 0.05），且研究组 的降低幅度均明显优于对照组（P < 0.01）。（3）肺循环指标方面，干预后，2 组患者的 mPAP、PCWP 水平均较干预前降低 （P < 0.05），且研究组的降低幅度均明显优于对照组（P < 0.01）。（4）CPET指标方面，干预后，2组患者的峰值心率、峰值收 缩压和峰值舒张压均较干预前降低（P < 0.05），VO2max和峰值氧脉搏均较干预前升高（P < 0.05），且研究组对峰值心率、峰 值收缩压和峰值舒张压的降低幅度及对VO2max和峰值氧脉搏的升高幅度均明显优于对照组（P < 0.05或P < 0.01）。（5）血管内 皮指标方面，干预后，2组患者的血清ET-1水平均较干预前降低（P < 0.05），血清NO水平均较干预前升高（P < 0.05），且研 究组对血清 ET-1 水平的降低幅度及对血清 NO 水平的升高幅度均明显优于对照组（P < 0.01）。（6）生活质量方面，干预后， 2 组患者健康调查简表（SF-36）的精神健康、情感职能、社会功能、生理功能、活力、总体健康等 6个领域的生活质量评分 均较干预前升高（P < 0.05），且研究组的升高幅度均明显优于对照组（P < 0.05或P < 0.01）。（7）不良反应方面，研究组的不良 反应发生率为20.00%（8/40），对照组为15.00%（6/40），组间比较，差异无统计学意义（P > 0.05）。【结论】 益气活血通脉汤与 西药联合应用能有效提高 PH-LHD气虚血瘀证患者临床疗效，改善患者心肺功能及血管内皮功能，提高患者生活质量，且 具有较高的安全性。

Objective To investigate the therapeutic efficacy of Yiqi Huoxue Tongmai Decoction （a modified priscription derived from Buyang Huanwu Decoction）combined with western medicines in the treatment of patients with pulmonary hypertension due to left heart disease（PH-LHD）of qi deficiency and blood stasis syndrome，and to explore its effect on endothelial function. Methods Eighty patients with PH-LHD of qi deficiency and blood stasis syndrome who were admitted to Shangluo Central Hospital from March 2022 to December 2023 were randomly divided into a study group and a control group，with 40 patients in each group. The control group was given routine treatment with western medicine， and the study group was treated with Yiqi Huoxue Tongmai Decoction on the basis of treatment for the control group，three weeks constituting a course of treatment. Before and after intervention，the two groups of patients were observed in the changes of traditional Chinese medicine（TCM） syndrome scores， pulmonary circulation indicators [mean pulmonary arterial pressure（mPAP）and pulmonary capillary wedge pressure（PCWP）]，cardiopulmonary exercise testing（CPET）indicators [peak heart rate，peak systolic blood pressure，peak diastolic blood pressure，maximal oxygen uptake（VO2max），peak oxygen pulse]， vascular endothelial function indicators [serum nitric oxide（NO）and endothelin 1（ET - 1）］ and the scores of quality of life. After treatment，the clinical efficacy and incidence of adverse reactions of the patients between the two groups were compared. Results（1）After three-week of intervention，the total effective rate of the study group was 90.00%（36/40），while that of the control group was 72.50%（29/40），and the comparison between the two groups（tested by chi-square test）showed that the efficacy of the study group was significantly superior to that of the control group（P < 0.05）.（2）After intervention，the primary symptom scores，secondary symptom scores and total TCM syndrome scores of the two groups of patients were all decreased compared with those before intervention （P < 0.05），and the decrease of the scores in the study group was significantly superior to that in the control group （P < 0.01）.（3）After intervention，the levels of pulmonary circulation indicators of mPAP and PCWP in the two groups were all decreased compared with those before intervention（P < 0.05），and the decrease in the study group were significantly superior to that in the control group（P < 0.01）.（4）After intervention，the CPET indicators of peak heart rate， peak systolic blood pressure and peak diastolic blood pressure in the two groups were all decreased（P < 0.05），while the VO2max and peak oxygen pulse rate were all increased compared with those before intervention（P < 0.05）， and the decrease of peak heart rate， peak systolic blood pressure and peak diastolic blood pressure as well as the increase of VO2max and peak oxygen pulse rate in the study group was significantly superior to that in the control group（P < 0.05 or P < 0.01）.（5）After intervention，the vascular endothelial function indicator of serum ET-1 level in the two groups was decreased compared with that before intervention（P < 0.05），and the serum NO level was increased compared with that before intervention（P < 0.05）， and the decrease of serum ET-1 level and the increase of serum NO level in the study group were significantly superior to those in the control group（P < 0.01）.（6）After intervention，the scores of six dimensions of 36-Item Short-Form Health Survey （SF-36）， including mental health， role-emotional， social functioning， rolephysical，vitality，and general health in the patients of the two groups were increased compared with those before intervention（P < 0.05），and the increase in the study group was significantly superior to that of the control group （P < 0.05 or P < 0.01）.（7）The incidence of adverse reactions in the study group was 20.00%（8/40）and that was 15.00%（6/40）in the control group，and the comparison between the two groups showed that the difference was not statistically significant （P > 0.05）. Conclusion Yiqi Huoxue Tongmai Decoction combined with western medicines is effective on enhancing the clinical efficacy for the intervention of patients with PH-LHD of qi deficiency and blood stasis syndrome，and can improve the patients􀆳 cardiopulmonary function，vascular endothelial function and improve the quality of life，with higher safety.

R543.2

陕西省自然科学基金基础研究计划项目（编号：2021JR324）