评估肾素-血管紧张素-醛固酮系统（RAAS）抑制剂对 COVID-19 结局的影响：一项荟萃分析。
Estimation of Renin-Angiotensin-Aldosterone-System (RAAS)-Inhibitor effect on COVID-19 outcome: A Meta-analysis.
机构信息
University of Buenos Aires, School of Medicine, Institute of Medical Research A Lanari, Ciudad Autónoma de Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET)-University of Buenos Aires, Institute of Medical Research (IDIM), Department of Molecular Genetics and Biology of Complex Diseases, Ciudad Autónoma de Buenos Aires, Argentina.
University of Buenos Aires, School of Medicine, Institute of Medical Research A Lanari, Ciudad Autónoma de Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET)-University of Buenos Aires, Institute of Medical Research (IDIM), Department of Clinical and Molecular Hepatology, Ciudad Autónoma de Buenos Aires, Argentina.
出版信息
J Infect. 2020 Aug;81(2):276-281. doi: 10.1016/j.jinf.2020.05.052. Epub 2020 May 28.
BACKGROUND AND RATIONALE
Some studies of hospitalized patients suggested that the risk of death and/or severe illness due to COVID-19 is not associated with the use of angiotensin-converting enzyme inhibitors (ACEIs) and/or angiotensin II receptor type 1 blockers (ARBs). Nevertheless, some controversy still exists and there is limited information of the ACEIs/ARBs effect size on COVID-19 prognosis.
AIM AND METHODS
We aimed to measure the effect of ACEIs and/or ARBs on COVID-19 severe clinical illness by a meta-analysis. Literature search included all studies published since the COVID-19 outbreak began (December 2019) until May 9, 2020. We analyzed information from studies that included tested COVID-19 patients with arterial hypertension as comorbidity prior to hospital admission and history of taking ACEIs, ARBs, or ACEIs/ARBs.
RESULTS
We included 16 studies that involved 24,676 COVID-19 patients, and we compared patients with critical (n = 4134) vs. non-critical (n = 20,542) outcomes. The overall assessment by estimating random effects shows that the use of ACEIs/ARBs is not associated with higher risk of in-hospital-death and/or severe illness among hypertensive patients with COVID-19 infection. On the contrary, effect estimate shows an overall protective effect of RAAS inhibitors/blockers (ACEIs, ARBs, and/or ACEIs/ARBs) with ∼ 23 % reduced risk of death and/or critical disease (OR: 0.768, 95%CI: 0.651-0.907, p=0.0018). The use of ACEIs (OR:0.652, 95%CI:0.478-0.891, p=0.0072) but not ACEIs/ARBs (OR:0.867, 95%CI:0.638-1.179, p =NS) or ARBs alone (OR:0.810, 95%CI:0.629-1.044, p=NS) may explain the overall protection displayed by RAAS intervention combined.
CONCLUSION
RAAS inhibitors might be associated with better COVID-19 prognosis.
背景与理由
一些针对住院患者的研究表明，COVID-19 导致的死亡和/或重病风险与血管紧张素转换酶抑制剂（ACEIs）和/或血管紧张素 II 受体 1 型阻滞剂（ARBs）的使用无关。然而，仍存在一些争议，并且 ACEIs/ARBs 对 COVID-19 预后影响的信息有限。
目的与方法
我们旨在通过荟萃分析来衡量 ACEIs 和/或 ARBs 对 COVID-19 严重临床疾病的影响。文献检索包括自 COVID-19 爆发开始（2019 年 12 月）至 2020 年 5 月 9 日期间发表的所有研究。我们分析了包括入院前患有高血压合并症且有 ACEIs、ARBs 或 ACEIs/ARBs 使用史的 COVID-19 患者的研究信息。
结果
我们纳入了 16 项研究，共涉及 24676 例 COVID-19 患者，我们比较了危重症（n=4134）与非危重症（n=20542）患者的结局。通过估计随机效应的综合评估表明，在 COVID-19 感染的高血压患者中，ACEIs/ARBs 的使用与住院死亡和/或重症的风险增加无关。相反，效应估计显示 RAAS 抑制剂/阻滞剂（ACEIs、ARBs 和/或 ACEIs/ARBs）具有整体保护作用，死亡和/或重症疾病的风险降低约 23%（OR：0.768，95%CI：0.651-0.907，p=0.0018）。ACEIs 的使用（OR：0.652，95%CI：0.478-0.891，p=0.0072）而非 ACEIs/ARBs（OR：0.867，95%CI：0.638-1.179，p=NS）或 ARBs 单独使用（OR：0.810，95%CI：0.629-1.044，p=NS）可能解释了 RAAS 干预联合治疗所显示的总体保护作用。
结论
RAAS 抑制剂可能与 COVID-19 的预后更好相关。
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