维立西呱联合罗沙司他治疗血透合并心肌梗死后慢性心力衰竭患者的临床研究OA

Objective To observe the effects and safety of vericiguat tablets combined with roxadustat capsules in hemodialysis patients with heart failure after myocardial infarction.Methods Hemodialysis patients with chronic heart failure after myocardial infarction were randomly assigned into the treatment group and the control group based on the random number table method.Patients in the control group orally took roxadustat capsules,beta-blockers,angiotensin Ⅱ receptor antagonists,statins,nitrates and lifestyle guidance as appropriate.Roxadustat capsules:for those weighing less than 60 kg,100 mg per time;for those weighing more than 60 kg,take 120 mg each time;3 times a week.Patients in the treatment group were given oral administration of vericiguat tablets on this basis,2.5 mg each time,once a day.The treatment duration lasted six months.The clinical efficacy,heart function-related indicators,apoptosis-related factors,inflammatory factors,endothelial function indicators,anemia,iron metabolism conditions and safety evaluation were compared between the two groups.Results A total of 125 cases were enrolled in this study.The treatment group included 63 cases,and the control group included 62 cases.After the treatment,the total effective rates of the treatment group and the control group were 90.48％(57 cases/63 cases)and 77.42％(48 cases/62 cases),respectively,and the difference was statistically significant(P＜0.05).After treatment,the left ventricular ejection fraction in the treatment and the control groups were(55.87±7.05)％and(50.02±6.13)％,respectively;the left ventricular end systolic volumes were(75.08±14.29)and(80.45±13.88)mL,respectively;the left ventricular end diastolic volumes were(109.61±21.25)and(117.91±24.73)mL,respectively;the 6-minute walking tests were(454.69±38.68)and(409.59±39.68)m,respectively;the B-type natriuretic peptide levels were(530.54±36.68)and(578.73±43.62)ng·L-1,respectively;the high-sensitivity troponin Ⅰ levels were(24.62±4.17)and(32.59±4.83)ng·L-1,respectively;the soluble apoptosis factor levels were(3.15±0.79)and(5.70±0.99)μg·L-1,respectively;the soluble apoptosis factor ligand levels were(2.30±0.57)and(9.06±1.40)μg·L-1,respectively;the interleukin-1 β levels were(5.47±0.72)and(7.96±0.66)pg·mL-1,respectively;the interleukin-6 levels were(14.36±2.95)and(18.77±3.11)pg·mL-1,respectively;the nitric oxide synthase levels were(55.00±5.25) and(50.40±5.83)U·mL-1,respectively;the nitric oxide levels were(128.86±28.04)and(117.62±23.15)μmol·L-1,respectively.The above indicators in the treatment group were statistically significantly different from those in the control group(all P＜0.05).The main adverse drug reactions in the treatment group were symptomatic hypotension,hyperkalemia and nausea and vomiting,while those in the control group were mainly nausea and vomiting,upper abdominal discomfort and fatigue.The total incidence of adverse drug reactions in the two groups was 9.52％(6 cases/63 cases)and 9.68％(6 cases/62 cases),respectively.There was no statistically significant difference(P＞0.05).Conclusion Vericiguat tablets combined with roxadusta capsules has improved the cardiac function and ventricular remodeling of hemodialysis patients with chronic heart failure after myocardial infarction,reduced inflammatory factors and apoptosis-related factors,protected vascular endothelia,and achieved remarkable clinical efficacy,which is superior to that of roxadustat capsules alone with basic drugs for chronic heart failure,and has fewer adverse reactions.