意大利米兰比科卡大学Giovanni Corrao研究团队分析了肾素-血管紧张素-醛固酮系统阻滞剂和Covid-19风险之间的关联。2020年5月1日出版的《新英格兰医学杂志》发表了这项成果。

使用血管紧张素受体阻滞剂（ARBs）和血管紧张素转化酶（ACE）抑制剂与2019冠状病毒病（Covid-19）风险之间的潜在关联尚未明确。

研究组在意大利的伦巴第地区进行了一项基于人群的病例对照研究。2020年2月21日至3月11日，共有6272例患者确诊为SARS-CoV-2感染，根据性别、年龄和居住城市将其与30759名地区卫生服务受益人（对照组）进行配对。

患者组和对照组的平均年龄为68±13岁，女性占37％。与对照组相比，感染患者中使用ACE抑制剂和ARB，以及其他抗高血压和非抗高血压药物更常见，且感染患者的临床状况较差。在所有感染患者或重症及致命性疾病的患者中，使用ARBs或ACE抑制剂均未显示与Covid-19有任何关联，且根据性别，这些变量之间也没有关联。

在这项大型队列研究中，由于Covid-19患者的心血管疾病患病率较高，因此在Covid-19患者中使用ACE抑制剂和ARB的比例高于对照组。但没有证据表明ACE抑制剂或ARB会增加COVID-19的患病风险。

附：英文原文

Title: Renin–Angiotensin–Aldosterone System Blockers and the Risk of Covid-19

Author: Giuseppe Mancia, M.D.,, Federico Rea, Ph.D.,, Monica Ludergnani, M.Sc.,, Giovanni Apolone, M.D.,, and Giovanni Corrao, Ph.D.

Issue&Volume: 2020-05-01

Abstract: BACKGROUND

A potential association between the use of angiotensin-receptor blockers (ARBs) and angiotensin-converting–enzyme (ACE) inhibitors and the risk of coronavirus disease 2019 (Covid-19) has not been well studied.

METHODS

We carried out a population-based case–control study in the Lombardy region of Italy. A total of 6272 case patients in whom infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed between February 21 and March 11, 2020, were matched to 30,759 beneficiaries of the Regional Health Service (controls) according to sex, age, and municipality of residence. Information about the use of selected drugs and patients’ clinical profiles was obtained from regional databases of health care use. Odds ratios and 95% confidence intervals for associations between drugs and infection, with adjustment for confounders, were estimated by means of logistic regression.

RESULTS

Among both case patients and controls, the mean (±SD) age was 68±13 years, and 37% were women. The use of ACE inhibitors and ARBs was more common among case patients than among controls, as was the use of other antihypertensive and non-antihypertensive drugs, and case patients had a worse clinical profile. Use of ARBs or ACE inhibitors did not show any association with Covid-19 among case patients overall (adjusted odds ratio, 0.95 [95% confidence interval {CI}, 0.86 to 1.05] for ARBs and 0.96 [95% CI, 0.87 to 1.07] for ACE inhibitors) or among patients who had a severe or fatal course of the disease (adjusted odds ratio, 0.83 [95% CI, 0.63 to 1.10] for ARBs and 0.91 [95% CI, 0.69 to 1.21] for ACE inhibitors), and no association between these variables was found according to sex.

CONCLUSIONS

In this large, population-based study, the use of ACE inhibitors and ARBs was more frequent among patients with Covid-19 than among controls because of their higher prevalence of cardiovascular disease. However, there was no evidence that ACE inhibitors or ARBs affected the risk of COVID-19.

DOI: NJ202005013822501

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2006923