目的 观察维立西呱联合左西孟旦治疗射血分数降低型慢性心力衰竭的疗效及其对心功能、血清因子的影响。方法 选取2022年9月—2024年9月开封市中心医院心内科收治的86例射血分数降低型慢性心力衰竭患者，按照随机数字表法分为对照组43例和治疗组43例。对照组给予左西孟旦注射液，初始以6 μg/kg，注射10 min，随即以0.1 μg/kg·min，应用输液泵静脉泵入，持续应用24 h。治疗组在对照组的治疗基础上口服维立西呱片，2.5 mg/次，1次/d。两组用药4周。观察两组的临床疗效，比较两组6 min步行距离（6MWD）、明尼苏达心功能不全生命质量量表（MLHFQ）评分、心功能指标和血清炎性因子水平。结果 治疗后，治疗组和对照组总有效率分别是95.35%、79.07%，两组比较差异显著（P＜0.05）。治疗后，两组6MWD距离较同组治疗前显著增加，MLHFQ评分降低（P＜0.05）；治疗后，与对照组对比，治疗组6MWD距离升高，且治疗组的MLHFQ评分降低（P＜0.05）。治疗后，两组左心室射血分数（LVEF）较前显著升高，而左心室舒张末内径（LVEDD）、左心室收缩末内径（LVESD）降低（P＜0.05）；治疗后，与对照组对比，治疗组的LVEF水平更高，且治疗组LVEDD、LVESD水平均更低（P＜0.05）。治疗后，两组白细胞介素-1β（IL-1β）、可溶性生长刺激表达基因2蛋白（sST2）、血浆基质蛋白酶9（MMP-9）、N末端前脑钠肽（NTproBNP）水平均较同组治疗前显著降低（P＜0.05）；治疗后，与对照组对比，治疗组的IL-1β、sST2、MMP-9、NTproBNP水平均更低（P＜0.05）。结论 维立西呱联合左西孟旦在射血分数降低型慢性心力衰竭患者中显示出显著的疗效，可改善心功能指标，同时能降低炎症标志物水平。

Objective To observe the therapeutic effect of vericiguat combined with levosimendan in treatment of chronic heart failure with reduced ejection fraction, as well as its influence on cardiac function and serum factors. Methods A total of 86 patients with reduced ejection fraction chronic heart failure who were admitted to the Cardiology Department of Kaifeng Central Hospital from September 2022 to September 2024 were selected. They were randomly divided into control group of 43 cases and treatment group of 43 cases according to the random number table method. Patients in control group were given Levosimendan Injection, with an initial dose of 6 μg/kg, administered intravenously over 10 min, then, at a rate of 0.1 μg/kg/min, it was infused through an infusion pump and continued for 24 h. Patients in treatment group received oral Vericiguat Tablets in addition to the treatment in control group, 2.5 mg each time, once daily. Both groups were administered the medication for 4 weeks. The clinical efficacy of two groups was observed, and the 6 min walking distance (6MWD), Minnesota Heart Failure Quality of Life Scale (MLHFQ) score, cardiac function indicators, and serum inflammatory factor levels were compared between two groups. Results After treatment, the total effective rates of treatment group and the control group were 95.35% and 79.07%, respectively, there was a significant difference between two groups (P < 0.05). After treatment, the 6MWD distances of both groups increased significantly compared to those before treatment in the same group, and MLHFQ scores decreased (P < 0.05). After treatment, compared with control group, the 6MWD distance of treatment group increased, and MLHFQ score of treatment group decreased (P < 0.05). After treatment, the left ventricular ejection fraction (LVEF) of both groups significantly increased compared to before, while the left ventricular diastolic end diameter (LVEDD) and left ventricular systolic end diameter (LVESD) decreased (P < 0.05). After treatment, compared with control group, the LVEF level of treatment group was higher, and LVEDD and LVESD levels of treatment group were lower (P < 0.05). After treatment, the levels of interleukin-1β (IL-1β), soluble growth stimulating expression gene 2 protein (sST2), plasma matrix metalloproteinase 9 (MMP-9), and N-terminal pro-brain natriuretic peptide (NTproBNP) in both groups were significantly lower than those before treatment in the same group (P < 0.05). After treatment, compared with control group, the levels of IL-1β, sST2, MMP-9, and NTproBNP in treatment group were lower (P < 0.05). Conclusion Vericiguat combined with levosimendan shows significant efficacy in patients with reduced ejection fraction chronic heart failure, and can improve cardiac function indicators and simultaneously reduce the levels of inflammatory markers.

R972

河南医学科技攻关计划联合共建项目（LHGJ20220927）