维利西呱及其抗心力衰竭的研究进展

Vericiguat and Its Anti-Heart Failure

心力衰竭(HF)是各种心脏疾病的临床终末阶段,是由多种原因引起心室充盈和/或射血功能受损,导致高住院率和发病率。根据2021年欧洲心脏病学会指南将其分为射血分数降低性心力衰竭(左室射血分数≤40%)、中间范围射血分数心力衰竭(左室射血分数为41%~49%)和射血分数保留性心力衰竭(左室射血分数≥50%)。在过去的30年中,HF的药物治疗主要针对交感神经系统和肾素-血管紧张素-醛固酮系统,但大量数据表明,其疗法无法满足当前需求,HF治疗亟待更新。近年来,HF的新疗法发展迅速。伊伐布雷定、血管紧张素受体-脑啡肽酶抑制剂、钠-葡萄糖共转运蛋白2抑制剂、维利西呱等疗法已被证明能改善射血分数降低性心力衰竭患者的预后。维利西呱作为中国新上市的新型治疗HF的药物,是一种口服的可溶性鸟苷酸环化酶刺激剂。现就其作用机制、临床研究、安全性、与其他药物的联合使用做系统性综述,进一步为临床合理用药提供依据。

Heart failure(HF)is the clinical end stage of various heart diseases.It is due to a variety of causes of ventricular filling and/or impaired ejection function,resulting in high hospitalization and morbidity.According to the 2021 European Society of Cardiology guideline,it is divided into HF with reduced ejection fraction(left ventricular ejection fraction≤40%),HF with mid-range ejection fraction(left ventricular ejection fraction 41%~49%),and HF with preserved ejection fraction(left ventricular ejection fraction≥50%).In the past thirty years,drug treatment of HF is aimed at the sympathetic nervous system and renin-angiotensin-aldosterone system,but a large amount of data showed that conventional therapies cannot meet the current needs,and HF treatment urgently needs to be updated.New therapy for HF has been rapidly developing in recent years.Therapies such as ivabradine,angiotensin receptor-neprilysin inhibitor,sodium-glucose cotransporter 2 inhibitor,and vericiguat have been proved to improve outcomes in patients with HF with reduced ejection fraction.Vericiguat as a new type of drug for the treatment of HF in China,it is a new oral soluble guanylate cyclase stimulator.This article provides a systematic review of its mechanism of action,clinical research,safety,and combination with other drugs to provide further basis for clinical rational drug use.