【目的】 观察益气温阳利水方（由五苓散合黄芪、葶苈子等加减化裁而成）治疗心力衰竭阳虚水泛证患者后心功能、心 脏重塑的变化情况及影响疗效的危险因素分析。【方法】 选取2022年2月至2024年1月聊城市中医医院收治的120例心力衰竭 阳虚水泛证患者作为研究对象，依据随机数字表法将患者随机分为观察组和对照组，每组各60例。对照组给予西医常规治 疗，观察组在对照组的基础上给予益气温阳利水方治疗，2组疗程均为2个月。观察2组患者治疗前后心功能指标和心脏重 塑指标的变化情况，评价2组患者的临床疗效，采用单因素分析和二元Logistic回归分析探讨影响益气温阳利水方治疗心力 衰竭阳虚水泛证患者疗效的独立危险因素。【结果】（1）疗效方面，治疗2个月后，观察组的总有效率为81.67%（49/60），对照 组为70.00%（42/60），组间比较（χ2 检验），观察组的疗效明显优于对照组（P＜0.05）。（2）心功能和心脏重塑指标方面，治疗后， 2组患者的心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）及血清N末端B型利钠肽原（NT-proBNP）水平均较治 疗前有所下降（P＜0.01），且观察组对 LVEDD、LVESD 值及血清 NT-proBNP 水平的下降幅度均明显优于对照组（P＜0.05 或 P＜0.01）。（3）单因素分析方面，美国纽约心脏病协会（NYHA）心功能分级、LVEDD、LVESD、NT-proBNP与益气温阳利水方 治疗心力衰竭阳虚水泛证患者的疗效有关（P＜0.05）。（4）多因素Logistic回归分析方面，NYHA分级、LVEDD、LVESD、NTproBNP均是影响益气温阳利水方治疗心力衰竭阳虚水泛证患者疗效的独立危险因素（P＜0.05），可分别将疗效为无效的风险 提升4.12、1.21、1.19及1.00倍。【结论】 益气温阳利水方可有效改善心力衰竭阳虚水泛证患者的心功能及心脏重塑，并可有 效改善患者临床症状，提升治疗效果；NYHA 分级、LVEDD、LVESD、NT-proBNP 均是影响益气温阳利水方治疗心力衰竭 阳虚水泛证患者疗效的独立危险因素，因此，在治疗过程中应密切关注这些指标的变化情况，及时调整治疗方案，以提 升治疗效果。

Objective To investigate the effects of Yiqi Wenyang Lishui Formula （derived from Wuling San combined with Astragali Radix and Descurainiae Semen Lepidii Semen） on cardiac function and remodeling in heart failure （HF） patients with yang deficiency and fluid retention syndrome and to analyze risk factors for influencing therapeutic efficacy. Methods A total of 120 HF patients with yang deficiency and fluid retention syndrome admitted to Liaocheng Hospital of Traditional Chinese Medicine from February 2022 to January 2024 were enrolled and randomly divided into observation group （n=60） and control group （n=60） using a random number table. The control group received conventional western therapy，while the observation group received Yiqi Wenyang Lishui Formula additionally. Both groups were treated for 2 months. Changes in cardiac function indicators and remodeling markers were observed. Clinical efficacy was evaluated，and univariate and binary logistic regression analyses were performed to identify independent risk factors affecting treatment outcomes. Results （1） The total effective rate was 81.67% （49/60） in the observation group versus 70.00% （42/60） in the control group. Intergroup comparison （by chi-square test） showed that the efficacy in the observation group was superior to the control group （P＜0.05）.（2） After treatment，both groups showed significant reductions compared to those before treatment in left ventricular end-diastolic diameter （LVEDD）， left ventricular end-systolic diameter （LVESD）， and Nterminal pro-brain natriuretic peptide （NT-proBNP）（P＜0.01）. The reduction in LVEDD，LVESD，and serum NTproBNP levels in the observation group was significantly greater than that in the control group （P＜0.05 or P＜ 0.01）. （3） Univariate analysis revealed that New York Heart Association （NYHA） functional classification， LVEDD，LVESD，and NT-proBNP levels were significantly associated with the therapeutic efficacy of the Yiqi Wenyang Lishui Formula in heart failure patients with yang deficiency and fluid retention syndrome （P＜0.05）. （4）Logistic regression identified NYHA classification，LVEDD，LVESD，and NT-proBNP as independent risk factors （P＜0.05） in affecting therapeutic effect of Yiqi Wenyang Lishui Formula in treating HF with yang deficency and fluid retention syndrome，increasing the risk of ineffective treatment by 4.12-fold，1.21-fold，1.19-fold， and 1.00-fold，respectively. Conclusion Yiqi Wenyang Lishui Formula effectively improves cardiac function and remodeling in HF patients with yang deficiency and fluid retention syndrome. NYHA classification， LVEDD， LVESD，and NT-proBNP are independent risk factors for influencing efficacy，warranting close monitoring for optimized therapeutic adjustments.

R259.416

山东省中医药科技计划项目（编号：M-2023086）