[肾素-血管紧张素-醛固酮阻滞剂与新型冠状病毒肺炎感染：是友还是敌？]
[Renin-angiotensin-aldosterone blockers and Covic-19 infection : friends or enemies ?].
作者信息
Pechère-Bertschi Antoinette, Ponte Belén, Wuerzner Grégoire
机构信息
Service de néphrologie et hypertension, HUG, 1205 Genève.
Service de néphrologie et hypertension, CHUV, 1011 Lausanne.
出版信息
Rev Med Suisse. 2020 May 13;16(693):1003-1007.
ACE2 is not only an enzyme that counters the effects of the renin-angiotensin-aldosterone system (RAAS) but is also the entry receptor for SARS-CoV-2, the virus of the Covid-19 pandemic. Some experimental data suggest that ACE inhibitors and ARBs increase ACE2 levels, thus raising concerns on their security in Covid-19 positive patients. However, some studies have shown protection by these drugs in lower tract respiratory infections and ARDS. The actual consensus is to continue the treatment with RAAS inhibitors, abrupt withdrawal, especially in patients with cardiac or renal conditions, being hazardous in terms of cardiovascular outcomes, except in patients hospitalized in intensive care with hemodynamic instability. This position statement is actually unanimous among all international learned societies.
血管紧张素转换酶2（ACE2）不仅是一种对抗肾素-血管紧张素-醛固酮系统（RAAS）作用的酶，还是2019冠状病毒病大流行的病原体严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的进入受体。一些实验数据表明，血管紧张素转换酶抑制剂（ACEI）和血管紧张素Ⅱ受体阻滞剂（ARB）会提高ACE2水平，因此人们对其在新冠病毒检测呈阳性患者中的安全性感到担忧。然而，一些研究表明这些药物对下呼吸道感染和急性呼吸窘迫综合征有保护作用。目前的实际共识是继续使用RAAS抑制剂进行治疗，突然停药，尤其是对于患有心脏或肾脏疾病的患者，在心血管预后方面存在风险，除非是在重症监护病房住院且有血流动力学不稳定的患者。这一立场声明在所有国际学术团体中实际上是一致的。
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