目的 探讨沙库巴曲缬沙坦治疗高血压合并慢性心力衰竭（CHF）患者的疗效以及对血管紧张素Ⅱ（AngⅡ）、成纤维细胞生长因子23（FGF23）水平的影响。方法 选取2018年1月至2019年12月于邢台市第三医院收治的原发性高血压合并CHF患者76例为研究对象，剔除脱落病例后，分为观察组（36例）和对照组（35例），两组均给予常规治疗，对照组口服培哚普利，观察组口服沙库巴曲缬沙坦，4周为1疗程，共3疗程。观察两组患者的临床疗效及治疗前后心力衰竭（心衰）症状、超声心动图、血管内皮功能及AngⅡ、FGF23水平变化，记录治疗期间不良反应。结果 观察组患者治疗有效率高于对照组（91.67% vs. 71.43%，P＜0.05）；治疗后两组患者心率明显下降，24 h尿量增加，且观察组心率低于对照组，24 h尿量高于对照组（P＜0.05）。治疗后两组左心室射血分数（LVEF）、6分钟步行试验（6MWT）均增加，左心室舒张末期内径（LVEDD）、N末端脑钠肽前体（NT-proBNP）水平较治疗前降低，且观察组LVEF、6MWT高于对照组，LVEDD、NT-proBNP水平低于对照组（P＜0.05）。治疗后两组内皮素-1（ET-1）、AngⅡ、FGF23水平较治疗前下降，一氧化氮（NO）水平升高，且观察组ET-1、AngⅡ、FGF23水平低于对照组，NO水平高于对照组（P＜0.05）。结论 与培哚普利相比，沙库巴曲缬沙坦治疗高血压合并CHF对缓解心衰症状、改善心功能、血管内皮功能和FGF23水平改善更为明显，疗效确切且安全性高。

Objective To investigate the curative effect of sakubatril-valsartan in patients with hypertension complicated by chronic heart failure (CHF) and its influence on levels of angiotensin Ⅱ (AngⅡ) and fibroblast growth factor 23 (FGF23). Methods The patients (n=76) with essential hypertension (EH) complicated by CHF were chosen from the Third Hospital of Xingtai City from Jan. 2018 to Dec. 2019, and divided into observation group (n=36) and control group (n=35). All groups were given routine treatment, and control group was orally given perindopril and observation group was given sakubatril-valsartan for 4 weeks as one therapeutic course. The treatment was lasted for 3 courses. The clinical efficacy and changes of HF symptoms, echocardiogram, vascular endothelial function and levels of AngII and FGF23 were observed before and after treatment and adverse reactions were recorded during therapeutic period in 2 groups. Results The curative effect rate was higher in observation group than that in control group (91.67% vs. 71.43%, P<0.05). After treatment, the heart rate (HR) decreased significantly and 24 h urine volume increased in 2 groups, and HR was lower and 24 h urine volume was higher in observation group than those in control group (P<0.05). After treatment, left ventricular ejection fraction (LVEF) and 6-minute walk test (6MWT) increased, and left ventricular enddiastolic inner diameter (LVEDD) and N-terminal pro-brain natriuretic peptide (NT-proBNP) decreased in 2 groups than before, and LVEF and 6MWT were higher and LVEDD and NT-proBNP were lower in observation group than those in control group (P<0.05). After treatment, the levels of endothelin-1 (ET-1), AngⅡ and FGF23 decreased, and level of nitric oxide (NO) increased in 2 groups, and levels of ET-1, AngⅡ and FGF23 were lower and NO level was higher in observation group than those in control group (P<0.05). Conclusion Compared with perindopril, sakubatril-valsartan has more significant effects of relieving HF symptoms and improving heart function, vascular endothelial function and FGF23 level with reliable curative effect and higher safety in patients with EH complicated by CHF.

河北省邢台市重点研发计划项目(2020ZC268)