维立西呱联合“新四联”药物对扩张型心肌病心衰患者的治疗效果分析  

Analysis of the therapeutic efficacy of vericiguat combined with“new quadruple”drugs in the treatment of heart failure caused by dilated cardiomyopathy

作　　者：刘加宝 张艳娟[1] 王连生[1] 赵迪 LIU Jiabao;ZHANG Yanjuan;WANG Liansheng;ZHAO Di(Department of Cardiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院心血管内科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2024年第12期1682-1689,共8页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家自然科学基金(81901416);江苏省自然科学基金(BK20191067)。

摘　　要：目的:探讨维立西呱联合“新四联”药物治疗扩张型心肌病(扩心病)所致心力衰竭的临床疗效及安全性。方法:纳入2022年12月1日—2024年2月1日在南京医科大学第一附属医院心内科门诊及病房连续入组扩心病心衰患者43例(男33例,女10例)。入组前测定患者的左房内径(left atrial diameter,LAD)、左室射血分数(left ventricular ejection fraction,LVEF)、左室舒张末内径(left ventricular end diastolic diameter,LVEDD)、N末端B型利钠肽原(NT-proBNP)、肝肾功能电解质、明尼苏达州心功能不全生存质量量表(Minnesota living with heart failure questionnaire,MLHFQ)及6 min步行试验距离(6-minute walk test,6MWT)等指标。对于射血分数降低的心衰(heart failure with reduced ejection fraction,HFrEF)及射血分数轻度降低的心衰(heart failure with mildly reduced ejection fraction,HFmrEF)患者给予维立西呱联合“ARNI、BB、MRA、SGLT2i”新四联药物治疗。对于射血分数保留的心衰(heart failure with preserved ejection fraction,HFpEF)患者给予维立西呱联合“ARNI、BB、SGLT2i”进行治疗。治疗3个月后复查并比较各项指标的变化。结果:在扩心病心衰患者中,治疗3个月后,LAD[(41.37±6.97)mm vs.(39.30±5.19)mm]、LVEF[(41.02±10.33)%vs.(46.43±10.74)%)]、LVEDD[(61.40±7.65)mm vs.(58.56±7.03)mm)]、NT-proBNP [1642.5(936.4,4019.0)ng/L vs.659.3(213.2,1297.0)ng/L)、MLHFQ(47.79±9.67 vs.34.86±8.94)]、6MWT[(348.85±82.43)m vs.(401.76±95.56)m]均显著改善(P均<0.01)。肝肾功能及电解质差异无统计学意义。亚组分析显示,维立西呱联合“ARNI、BB、MRA、SGLT2i”提高了扩心病所致HFrEF、HFmrEF及HFpEF心衰患者的LVEF,降低了LVEDD及NT-proBNP水平,并改善了患者的6MWT。结论:维立西呱联合“新四联”药物对扩心病心衰患者的治疗效果显著。本研究为临床扩心病心衰患者的治疗提供了潜在的数据支持及指导。Objective:To explore the clinical efficacy and safety of vericiguat combined with the“new quadruple”in treating heart failure caused by dilated cardiomyopathy(DCM).Methods:Between December 1,2022 and February 1,2024,a total of 43 patients with heart failure resulting from DCM(33 males,10 females)were consecutively recruited from the outpatient clinic and inpatient wards of the Cardiology Department at the First Affiliated Hospital of Nanjing Medical University.Before treatment,various parameters were measured,including left atrial diameter(LAD),left ventricular ejection fraction(LVEF),left ventricular end⁃diastolic diameter(LVEDD),N⁃terminal pro B⁃type natriuretic peptide(NT⁃proBNP),liver and kidney function,electrolytes,Minnesota Living with Heart Failure Questionnaire(MLHFQ)scores,and 6⁃minute walk test(6MWT)distances.Patients with heart failure with reduced ejection fraction(HFrEF)or mildly reduced ejection fraction(HFmrEF)were treated with vericiguat combined with“ARNI,BB,MRA,SGLT2i”(the“new quadruple”therapy).For patients with heart failure with preserved ejection fraction(HFpEF),vericiguat was combined with ARNI,BB,and SGLT2i.After 3 months of treatment,the aforementioned indicators were re⁃evaluated and compared with baseline values.Results:After 3 months of treatment,significant improvements were observed in all DCM patients with heart failure:LAD[(41.37±6.97)mm vs.(39.30±5.19)mm,P<0.01)];LVEF[(41.02±10.33)%vs.(46.43±10.74)%,P<0.01)];LVEDD[(61.40±7.65)mm vs.(58.56±7.03)mm,P<0.01)];NT⁃proBNP[1642.5(936.4,4019.0)ng/L vs.659.3(213.2,1297.0)ng/L,P<0.01)];MLHFQ(47.79±9.67 vs.(34.86±8.94),P<0.01);6MWT[(348.85±82.43)m vs(.401.76±95.56)m,P<0.01)].No significant differences were found in liver or kidney function,or electrolytes levles.Further subgroup analysis showed that vericiguat combined with ARNI,BB,MRA,and SGLT2i improved the LVEF,reduced LVEDD and NT⁃proBNP levels,and enhanced 6MWT performance in patients with HFrEF,HFmrEF,and HFpEF due to DCM.Conclusion:Vericiguat comb

关 键 词：心力衰竭 维立西呱 新四联药物 扩张型心肌病 

分 类 号：R542.2[医药卫生—心血管疾病]