【摘要】 基于新活素降低心脏前后负荷和左西孟旦增强心肌收缩力的不同作用机制，评估两药联合使用对顽固性心力衰竭患者短期临床结局的影响。单中心回顾性研究采用倾向得分匹配法，将163例顽固性心力衰竭患者分为联合治疗组(新活素+左西孟旦+常规治疗，n=60)和常规治疗组(n=60)。主要终点为30 d全因死亡率和再住院率；次要终点包括NT-proBNP水平、LVEF、6MWD和MLHFQ评分变化。联合治疗组30 d全因死亡率显著降低(5.0%vs 16.7%,P=0.037),再住院率也明显减少(11.7%vs 26.7%,P=0.014)。联合治疗组在NT-proBNP水平下降、LVEF改善、6MWD增加和MLHFQ评分提高方面均优于常规治疗组(均P<0.001)。两组不良事件发生率无显著差异。新活素与左西孟旦联合使用可能显著改善顽固性心力衰竭患者的短期临床结局，包括降低死亡率和再住院率，改善心功能和生活质量。这种联合策略为顽固性心力衰竭管理提供了新选择，但仍需前瞻性随机对照试验进一步验证其有效性和安全性。更多还原

【Abstract】 Based on the distinct mechanisms of action of these two drugs, to evaluate the impact of combined use of nesiritide(recombinant human brain natriuretic peptide) and levosimendan on short-term clinical outcomes in patients with refractory heart failure, this single-center retrospective cohort study collected clinical data from 163 patients with refractory heart failure treated between January 2021 and December 2023.Patients were divided into two groups using propensity score matching: A combined therapy group(nesiri-tide + levosimendan + conventional treatment, n=60) and a conventional treatment group(n=60).The primary endpoints were 30-day all-cause mortality and rehospitalization rates.Secondary endpoints included changes in N-terminal pro-brain natriuretic peptide(NT-proBNP) levels, improvement in left ventricular ejection fraction(LVEF),6-minute walk distance(6MWD),and Minnesota Living with Heart Failure Questionnaire(MLHFQ) scores.Nesiritide was administered as a continuous intravenous infusion at 0.01μg/(kg·min) for 48 hours, while levosimendan was given at 0.1 μg/(kg·min) for 24 hours, both in addition to standard heart failure therapy.After propensity score matching, the combined therapy group showed significantly lower 30-day all-cause mortality compared to the conventional treatment group(5.0% vs 16.7%,P=0.037).The rehospitalization rate was also markedly reduced in the combined therapy group(11.7% vs 26.7%,P=0.014).Secondary endpoints demonstrated substantial improvements in the combined therapy group.NT-proBNP levels decreased more significantly in the combined therapy group(P<0.001),indicating a greater reduction in cardiac wall stress.LVEF improved more prominently in the combined therapy group(P<0.001),suggesting enhanced cardiac systolic function.The 6MWD increased more substantially in the combined therapy group(P<0.001),reflecting improved exercise capacity.MLHFQ scores showed greater improvement in the combined therapy group(P<0.001),indicating a more significant enhancement in quality of life.Importantly, there was no significant difference in the incidence of adverse events between the two groups, suggesting that the combined therapy did not increase the risk of side effects.The combined use of nesiritide and levosimendan may significantly improve short-term clinical outcomes in patients with refractory heart failure.This improvement encompasses reduced mortality and rehospitalization rates, enhanced cardiac function, increased exercise capacity, and improved quality of life.The similar safety profile between the groups suggests that this combined approach does not introduce additional risks.This novel combined treatment strategy offers a promising new option for the management of refractory heart failure, potentially addressing an important unmet clinical need.However, while these results are encouraging, they should be interpreted with caution due to the study’s retrospective nature and single-center design.Further validation through prospective, multi-center randomized controlled trials is necessary to definitively establish the efficacy and safety of this combined therapy approach.Future studies should also explore the optimal dosing regimen, duration of treatment, and identify patient subgroups most likely to benefit from this combined therapy.更多还原