简介：　　摘要：目的 探讨联合应用培哚普利和坎地沙坦治疗慢性充血性心力衰竭 (CHF)的疗效及对心室重构的影响。方法将 160例 CHF患者随机分为对照组、培哚普利组、坎地沙坦组和联合治疗组，每组 40例，共治疗 16周。对照组采用常规治疗；培哚普利组在常规治疗基础上加用培哚普利治疗；坎地沙坦组在常规治疗基础上加用坎地沙坦治疗；联合治疗组在常规治疗基础上加用培哚普利、坎地沙坦治疗。治疗中，观察评价各组患者左心功能和左心室形态［左室射血分数（ LVEF）、左室收缩末期内径 (LVESD)、左室后壁厚度 (LVPWT)、左室舒张末期内径 (LVEDD)、室间隔厚度 (IVST)］、心肌重塑相关细胞因子［白介素 6（ IL6）、基质金属蛋白酶（ MMP） 3、 MMP 9］以及药物治疗安全性。结果联合治疗组总有效率为 100.0%高于培哚普利组（ 90.0%）、坎地沙坦组（ 87.5%）、对照组（ 65.0%），差异有统计学意义（ P＜ 0.05）。与对照组比较，其他 3组 LVESD、 LVEDD、 IVST、 LVPWT与 IL6、 MMP3、 MMP9均显著下降， LVEF显著升高，差异有统计学意义（ P＜ 0.05），且联合治疗组各上述指标均优于培哚普利组和坎地沙坦组（ P＜ 0.05）。 4组治疗安全性差异无统计学意义（ P＞ 0.05）。结论培哚普利与坎地沙坦均能够改善患者心功能的改善，抑制心室重塑 ,且两者联合治疗疗效更好。  　　关键词：慢性心力衰竭；培哚普利；坎地沙坦；心室重塑  ABSTRACT: Objective To investigate the efficacy of perindopril and candesartan in the treatment of chronic congestive heart failure (CHF) and its effect on ventricular remodeling. Methods 160 patients with CHF were randomly divided into control group, perindopril group, candesartan group and combined treatment group, 40 cases in each group for 16 weeks. The control group was treated with routine treatment; the perindopril group was treated with perindopril on the basis of routine treatment; the Candesartan group was treated with candesartan on the basis of routine treatment; the combined treatment group was treated with perindopril and candesartan on the basis of routine treatment. During the treatment, left ventricular function and left ventricular morphology [left ventricular ejection fraction (LVEF), left ventricular end systolic diameter (LVESD), left ventricular posterior wall thickness (LVPWT), left ventricular end diastolic diameter (LVEDD), interventricular septal thickness (IVST)], cytokines related to myocardial remodeling [interleukin 6 (IL6), matrix metalloproteinase (MMP) were observed and evaluated. (MMP) 3, MMP 9 and drug safety. Results The total effective rate of combined treatment group was 100.0% higher than that of perindopril group (90.0%), candesartan group (87.5%) and control group (65.0%). The difference was statistically significant (P < 0.05). Compared with the control group, LVESD, LVEDD, IVST, LVPWT, IL6, MMP3 and MMP9 in the other three groups decreased significantly, and LVEF increased significantly (P < 0.05), and the above indexes in the combined treatment group were better than those in perindopril group and candesartan group (P < 0.05). There was no significant difference in treatment safety between the four groups (P > 0.05). Conclusion Both perindopril and candesartan can improve cardiac function and inhibit ventricular remodeling, and the combined treatment of perindopril and candesartan is more effective.