【目的】 分析利水强心汤（由生黄芪、大腹皮、葶苈子、茯苓、猪苓、桂枝、丹参、阿胶、木香等组成）加减治疗老年 慢性心力衰竭（CHF）的临床疗效及其对心室重构和血清可溶性肿瘤坏死因子样凋亡微弱诱导剂（sTWEAK）、超敏C反应蛋白 （hs-CRP）、白细胞介素 6（IL-6）水平的影响。【方法】 选取 2021 年 12 月至 2024 年 12 月在唐山中心医院就诊的 150 例阳气虚 衰、水泛血瘀证老年CHF患者，根据治疗方法的不同将其分为试验组76例和基础组74例。基础组给予标准化西医治疗（包 括扩血管、利尿、强心等），试验组在基础组的治疗基础上给予利水强心汤加减治疗，疗程为8周。观察2组患者治疗前后 中医证候积分、明尼苏达心力衰竭生活质量问卷（MLHFQ）评分、心室重构指标[左心室质量（LVM）、左心室舒张早期二尖瓣 血流最大速度/左心室舒张晚期二尖瓣血流最大速度（E/A）、左室射血分数（LVEF）]及血清sTWEAK、hs-CRP、IL-6水平的变 化情况，并评价 2 组患者的临床疗效。【结果】（1）疗效方面，治疗 8 周后，试验组的总有效率为 97.37%（74/76），基础组为 86.49%（64/74），组间比较（χ2 检验），试验组的疗效明显优于基础组（P＜0.05）。（2）中医证候积分方面，治疗后，2组患者的 呼吸困难、面肢浮肿、畏寒肢冷、心悸气短积分均较治疗前降低（P＜0.05），且试验组的降低幅度均明显优于基础组（P＜ 0.01）。（3）心室重构指标方面，治疗后，2组患者的LVM均较治疗前降低（P＜0.05），E/A、LVEF均较治疗前升高（P＜0.05）， 且试验组对LVM的降低幅度及对E/A、LVEF的升高幅度均明显优于基础组（P＜0.01）。（4）血清炎症因子方面，治疗后，2组 患者的血清 sTWEAK、hs-CRP、IL-6 水平均较治疗前降低（P＜0.05），且试验组的降低幅度均明显优于基础组（P＜0.01）。 （5）生活质量方面，治疗后，2组患者MLHFQ量表的情感维度、身体活动维度、症状维度评分及其总分均较治疗前降低（P＜ 0.05），且试验组的降低幅度均明显优于基础组（P＜0.01）。【结论】 利水强心汤加减可有效缓解阳气虚衰、水泛血瘀证老年 CHF患者临床症状，改善左心室功能，降低血清sTWEAK、hs-CRP、IL-6水平，提高生活质量。

Objective To evaluate the clinical efficacy of modified Lishui Qiangxin Decoction （composed of Astragali Radix， Arecae Pericarpium， Descurainiae Semen Lepidii Semen， Poria， Polyporus， Cinnamomi Ramulus， Salviae Miltiorrhizae Radix et Rhizoma， Asini Corii Colla， Aucklandiae Radix， etc.） for elderly patients with chronic heart failure （CHF），and to investigate its effects on ventricular remodeling and serum levels of soluble tumor necrosis factor-like weak inducer of apoptosis （sTWEAK），high-sensitivity C-reactive protein （hs-CRP），and interleukin 6（IL-6）. Methods A total of 150 elderly CHF patients with yang-qi deficiency and water retention-blood stasis syndrome treated at Tangshan Central Hospital from December 2021 to December 2024 were enrolled. The patients were divided into trial （n=76）group and control （n=74） group. The control group received standard western treatment （vasodilation， diuresis， and cardiotonic therapy）， while the trial group received additional modified Lishui Qiangxin Decoction，both groups were treated for 8 weeks. The changes in traditional Chinese medicine （TCM） syndrome scores， Minnesota Living with Heart Failure Questionnaire （MLHFQ） scores，ventricular remodeling parameters [left ventricular mass （LVM），early to late diastolic mitral inflow velocity ratio （E/A）， left ventricular ejection fraction （LVEF）]， serum sTWEAK，hs-CRP，and IL-6 levels were observed，and clinical efficacy was evaluated. Results （1） After 8 weeks of treatment， the overall response rate in the trial group was 97.37% （74/76），while that in the control group was 86.49% （64/74）. The intergroup comparison （by chi-square test） showed that the efficacy of the trial group was significantly superior to that of the control group （P＜0.05）.（2） After treatment，the TCM syndrome scores for dyspnea，edema，cold intolerance and cold limbs， and palpitations and shortness of breath were significantly lower in both groups compared to before treatment （P＜0.05）. Additionally，the reduction in scores was significantly greater in the trial group than in the control group （P＜0.01）.（3） After treatment，the LVM of both groups decreased compared to before treatment （P＜0.05）， and the E/A and LVEF increased compared to before treatment （P＜0.05）. The reduction in LVM and the increase in E/A and LVEF in the trial group were significantly greater than those in the control group （P＜0.01）.（4） After treatment，the serum levels of sTWEAK，hs-CRP，and IL-6 in both groups decreased compared to before treatment （P＜0.05），and the reduction in the trial group was significantly greater than that in the control group （P＜0.01）.（5） After treatment， the MLHFQ scores of emotional， physical， symptom dimensions and total score of the MLHFQ scale in both groups decreased compared to before treatment （P＜0.05），and the reduction in the trial group was significantly greater than that in the control group （P＜0.01）. Conclusion Modified Lishui Qiangxin Decoction effectively alleviates symptoms， improves left ventricular function，reduces inflammatory markers of sTWEAK，hs-CRP and IL-6，and enhances quality of life in elderly CHF patients with yang-qi deficiency and water retention-blood stasis syndrome.

R259.416

国家自然科学基金资助项目（编号：81804045）；河北省卫生健康委医学科学基金资助项目（编号：20241851）