维立西呱在心力衰竭患者治疗中应用的研究进展  

Research progress of vericiguat in treatment of patients with heart failure

作　　者：冯嘉旭 张于 郭宝林 贾腾飞 卢作成 高旭 孙冬冬 FENG Jia-xu;ZHANG Yu;GUO Bao-lin;JIA Teng-fei;LU Zuo-cheng;GAO Xu;SUN Dong-dong(Department of Cardiology,First Affiliated Hospital,Air Force Medical University,Xi’an 710032,Shaanxi,China;Second Department of Internal Medicine,People's Hospital of Baihe County,Ankang 725800,Shaanxi,China;Department of Cardiology,People’s Hospital of Qin’an County,Tianshui 741600,Gansu,China)

机构地区：[1]空军军医大学第一附属医院心脏内科,陕西西安710032 [2]白河县人民医院内二科,陕西安康725800 [3]秦安县人民医院心内科,甘肃天水741600

出　　处：《心脏杂志》2025年第2期221-227,共7页Chinese Heart Journal

摘　　要：近年来,心力衰竭(心衰)在治疗方面取得了很大进展,美国和欧洲等指南已进行了多次更新,但从长远来看,心衰患者的死亡和再住院风险依然很高。维立西呱(Vericiguat)能够通过刺激和激活可溶性鸟苷酸环化酶(soluble guanylate cyclase,sGC)来修复该信号通路中的缺陷,增加环磷酸鸟苷(cyclic guanosine monophosphate,cGMP)水平,减少与心衰相关联的炎症反应、氧化应激反应以及血管内皮功能障碍。基于此,国外学者进行了两项著名的临床随机对照试验(randomized control trials,RCTs)——SOCRATES-REDUCEDⅡ期研究和VICTORIAⅢ期研究发现,维立西呱对于射血分数降低的心衰(heart failure with reduced ejection fraction,HFrEF)和近期心脏失代偿的患者是安全、有效的,且耐受性良好,能够显著降低HFrEF患者心血管不良事件的发生率。另外,对于射血分数保留的心衰(heart failure with preserved ejection fraction,HFpEF)患者,另有两项RCTs——SOCRATES-PRESERVED试验和VITALITY试验显示其生活质量和健康状况均得到了一定改善,但同时也证实维立西呱对于改善HFpEF患者的预后效果仍然有限。因此还需要进一步的研究才能明确该药物在心衰综合征患者治疗中的作用。本文综述了维立西呱在心衰患者,主要是HFrEF和HFpEF患者中的治疗作用、机制以及相关循证医学证据。Heart failure(HF)remains a major burden,with many patients facing a considerable risk of death or recurrent hospitalization.Vericiguat,a novel oral soluble guanylate cyclase(sGC)stimulator,increases the activity of the second messenger cyclic guanosine monophosphate(cGMP),which is involved in regulation of protective cardiovascular actions with a reduction in HF-related inflammation and oxidative stress and endothelial dysfunction.Two main clinical randomized control trials(RCTs),the SOCRATES-REDUCED phaseⅡstudy and the VICTORIA phaseⅢstudy,found that vericiguat is safe,well-tolerated,and effective with an absolute event-rate reduction in patients affected by HF with reduced ejection fraction(HFrEF)and recent cardiac decompensation.In patients with preserved ejection fraction(HFpEF),the SOCRATES-PRESERVED trial and the VITALITY trial demonstrated an improvement in quality of life and health status,but with a limited effect on prognosis.Further clinical trials of vericiguat are needed to determine the potential role of this drug for patients with chronic HF.This article will review the therapeutic effect,the mechanism and the evidence-based medicine of vericiguat in HFrEF and HFpEF.

关 键 词：维立西呱 心力衰竭 可溶性鸟苷酸环化酶 环磷酸鸟苷 

分 类 号：R541.6[医药卫生—心血管疾病]