【作者】 李伟；

【导师】 周新春；

【作者基本信息】 南昌大学 ， 临床医学（专业学位）， 2025， 硕士

【摘要】 目的:通过病例数据系统,对既往使用过维立西呱的射血分数降低型心力衰竭患者进行回顾性分析,进一步评估维立西呱在治疗射血分数降低型心力衰竭中的优势,为心血管临床医生用药的选择提供数据依据和优化建议。方法:从上饶市人民医院病例数据系统中收集2022年12月至2024年6月在上饶市人民医院以心力衰竭为主诊断的住院病人且符合纳入和排除标准的慢性心力衰竭患者180例,根据用药情况分为:维立西呱组(观察组,n=60)和常规治疗治疗组(对照组,n=120),收集所有患者的临床数据,包括性别、年龄、吸烟史、糖尿病病史,纽约心脏病协会(NYHA)心功能分级、肌酐、肾小球滤过率、N端B型利钠肽前体(NT-pro BNP)、电解质、心脏超声心动图相关指标以及药物治疗和非药物治疗情况等。随访两组患者治疗出院后1月、6月的再住院率和全因死亡率。观察两组患者住院治疗后临床数据的变化情况。结果:1.两组患者治疗前一般临床资料比较结果表明,两组患者在性别、年龄、心率、收缩压、舒张压、肌酐、血钾、糖尿病病史之间的差异均无统计学意义(P>0.05)。2.患者住院治疗前后,维立西呱组NT-pro BNP(P<0.001)减少,血钾(P<0.001)增加,差异具有统计学意义。其他指标治疗前后差异无统计学意义。常规治疗组NT-pro BNP减少(P<0.001),血钾升高(P<0.001),差异具有统计学意义,其他指标治疗前后差异无统计学意义。3.维立西呱组患者出院1月后,超声心动图数据与治疗前比较,左心室舒张末期内径LVDD减少(P<0.001),左心室射血分数LVEF增加(P<0.001),差异具有统计学意义。常规治疗组左心室舒张末期内径减小(P<0.001),左心室射血分数增加(P<0.001),差异具有统计学意义。两组患者治疗1月后左心室舒张末期内径LVDD和左心室射血分数LVEF治疗前后差值差异无统计学意义。出院治疗6月后,维立西呱组左心室舒张内径LVDD减小(P<0.001),左心室射血分数LVEF增加(P<0.001),差异具有统计学意义。常规治疗组左心室舒张末期内径LVDD减小(P<0.001),左心室射血分数LVEF增加(P<0.001),差异具有统计学意义。两组患者治疗6月后左心室舒张末期内径LVDD和左心室射血分数LVEF治疗前后差值差异无统计学意义(P>0.05)。4.随访6个月期间,维立西呱组患者再住院率为20.0%,基础治疗组再住院率34.2%,差异具有统计学意义(P<0.05)。维立西呱组患者全因死亡率8.3%,基础治疗组患者全因死亡率14.2%,差异无统计学意义(P>0.05)。两组患者治疗期间高钾血症、症状性低血压、晕厥的发生率差异无统计学意义(P>0.05)。结论:1.在真实世界中,射血分数降低型心力衰竭患者加用维立西呱可以有效减低患者再住院率。2.射血分数降低型心力衰竭患者加用维立西呱不会增加不良反应的发生率,安全性高。对死亡率的影响无统计学意义。更多还原

【Abstract】 Objective:Through the case data system,a retrospective analysis was conducted on patients with heart failure with reduced ejection fraction(HFr EF)who had previously been treated with vericiguat.This study further evaluated the therapeutic advantages of vericiguat in the treatment of HFr EF,providing data-based evidence and optimization suggestions for medication choices for cardiovascular clinicians.Methods:A total of 180 patients with chronic heart failure who were admitted to Shangrao People’s Hospital with heart failure as the primary diagnosis between December2022 and June 2024 and met the inclusion and exclusion criteria were selected from the case data system of Shangrao People’s Hospital.The patients were divided into two groups based on their treatment:the Vericiguat group(observation group,n=60)and the traditional pharmacological therapy group(control group,n=120).Clinical data of all patients were collected,including gender,age,smoking history,history of diabetes,New York Heart Association(NYHA)functional class,creatinine,glomerular filtration rate,N-terminal pro-B-type natriuretic peptide(NT-pro BNP),electrolytes,echocardiographic parameters,and details of pharmacolog-ical and non-pharmacological treatments.Follow-up was conducted to assess the readmission rate and all-cause mortality at 1 month and 6 months after discharge in both groups.Additionally,changes in clinical data after hospitalization were observed in both groups.Results:1.The comparison of baseline clinical characteristics between the two groups of patients before treatment showed that there were no statistically significant differences between the two groups in terms of gender,age,heart rate,systolic blood pressure,diastolic blood pressure,creatinine,serum potassium,and history of diabetes(P>0.05).2.In the Vericiguat group,NT-pro BNP decreased(P<0.001),while creatinin-eserum potassium(P<0.001)increased,and these differences were statistically significant.Other indicators showed no statistically significant differences before and after treatment.In the conventional treatment group,NT-pro BNP decreased(P<0.001)and serum potassium increased(P<0.001),with these differences being statistically significant,while other indicators showed no statistically significant differences before and after treatment.3.In the Vericiguat group,one month after discharge,echocardiographic data showed a decrease in left ventricular end-diastolic diameter(LVDD)(P<0.001)and an increase in left ventricular ejection fraction(LVEF)(P<0.001)compared with before treatment,with these differences being statistically significant.In the conventional treatment group,there was also a decrease in LVDD(P<0.001)and an increase in LVEF(P<0.001),with these differences being statistically significant.However,the differences in the changes of LVDD and LVEF before and after treatment between the two groups were not statistically significant.Six months after discharge,in the Vericiguat group,there was a significant decrease in LVDD(P<0.001)and an increase in LVEF(P<0.001),with these differences being statistically significant.Similarly,in the conventional treatment group,there was a decrease in LVDD(P<0.001)and an increase in LVEF(P<0.001),with these differences being statistically significant.However,the differences in the changes of LVDD and LVEF before and after treatment between the two groups after six months of treatment were not statistically significant(P>0.05).4.During the follow-up period,the readmission rate in the Vericiguat group was20.0%,compared with 34.2%in the conventional treatment group,with a statistically significant difference(P<0.05).The all-cause mortality rate was 8.3%in the Vericiguat group and 14.2%in the conventional treatment group,with no statistically significant difference(P>0.05).No statistically significant differences were observed between the two groups in the incidence of hyperkalemia,symptomatic hypotension,or syncope during treatment(P>0.05).Conclusion:1.In real-world settings,the addition of vericiguat in patients with heart failure and reduced ejection fraction(HFr EF)can effectively reduce the rate of rehospitalization.2.The addition of vericiguat in patients with HFr EF does not increase the incidence of adverse reactions and is highly safe.Its impact on mortality is not statistically significant.更多还原