抗胰岛素转化酶抑制剂或抗胰岛素受体阻断剂与COVID-19诊断和死亡率的联系
Emil L Fosbøl1, Jawad H Butt1, Lauge Østergaard1
1The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
JAMA
|June 20, 2020
概括
血管激素转化酶抑制剂 (ACEI) /血管激素受体抑制剂 (ARB) 的使用与高血压患者的COVID-19诊断率较高或结果较差无关. 这些发现支持在疫情期间继续使用ACEI/ARB.
科学领域:
- 心血管医学
- 感染性疾病
- 药理学
背景情况:
- 假设表明血管激素转化酶抑制剂 (ACEI) /血管激素受体抑制剂 (ARB) 可能会增加对COVID-19的易感性并恶化结果.
- 这种担忧源于血管酶转化酶2的潜在上调,这是SARS-CoV-2的功能受体.
研究的目的:
- 调查ACEI/ARB使用与COVID-19诊断之间的关联.
- 检查ACEI/ARB的使用是否与被诊断为COVID-19的患者的恶化结果相关.
主要方法:
- 一个回顾性队列研究使用了丹麦国家行政登记.
- 鉴定和跟踪COVID-19患者的死亡率和严重疾病.
- 一个嵌套的病例控制框架评估了使用ACEI/ARB与其他抗高血压剂的高血压患者的COVID-19诊断易感性.
主要成果:
- 在4480名COVID-19患者中,ACEI/ARB使用 (20.0%) 与30天死亡率 (调整HR,0.83) 或死亡/严重COVID-19 (调整HR,1.04) 的增加没有显著关联.
- 在对571名COVID-19患者和5710名高血压对照者的敏感性分析中,ACEI/ARB使用 (86.5%) 与更高的COVID-19诊断发生率无关 (调整后HR为1.05).
结论:
- 之前使用的ACEI/ARB与高血压患者的COVID-19诊断没有显著的关联.
- 在COVID-19患者中,ACEI/ARB的使用与死亡率或严重疾病的增加无关.
- 这些研究结果不支持在COVID-19大流行期间停止使用临床指示的ACEI/ARB药物.
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