史立英,于 凝

目的：评估可溶性鸟苷酸环化酶（soluble guanylate cyclase，sGC）刺激剂维立西呱在慢性心力衰竭（Chronic heart failure，CHF）患者中的临床疗效及安全性。方法：选取2024年1月至2025年6月期间于北京丰台医院确诊为CHF患者62例，经随机分组后分别纳入治疗组（n=32）与对照组（n=30）。对照组接受基于循证医学证据的药物治疗方案（guideline-directed medical therapy，GDMT），包括β受体阻滞剂、盐皮质激素受体拮抗剂、血管紧张素转换酶抑制剂/血管紧张素II受体阻滞剂/血管紧张素受体-脑啡肽酶抑制剂、钠-葡萄糖协同转运蛋白2抑制剂以及利尿剂、扩血管药物等，并依据血压、心率等参数实施个体化调整。治疗组则在此基础上联用维立西呱（起始2.5 mg，qd，随餐口服；其后约每2周在血压可耐受前提下倍增剂量，直至最大10 mg qd）。两组均随访6个月。对比分析两组患者心血管死亡或因心力衰竭住院率，两组B型钠尿肽（B-type natriuretic peptide，BNP）、纽约心脏病协会（NYHA）心功能分级、左心室射血分数（left ventricular ejection fraction，LVEF）及安全性相关指标（血压、血红蛋白、肾功能、电解质）。结果：6个月随访期内，两组均未出现心血管死亡病例，两组心衰住院率无统计学差异（9.38%vs.16.67%，P＞0.05）。虽然BNP下降幅度在组间比较中未达统计学显著（P＞0.05）。然而治疗组NYHA分级改善比例更高（P＜0.05），且LVEF升高程度亦呈现显著优势（P＜0.05）。治疗组前后血压、血肌酐、血钾及血红蛋白无显著变化，且与对照组比较差异均无统计学意义（均P＞0.05）。结论：维立西呱应用于CHF患者的临床疗效确切且安全性可靠。

慢性心力衰竭；维立西呱；左室射血分数；疗效；安全性

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