使用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂的患者的病毒感染风险：一项全国范围内基于倾向评分匹配的研究。

Risk of Viral Infection in Patients Using Either Angiotensin-converting Enzyme Inhibitors or Angiotensin Receptor Blockers: A Nationwide Population-based Propensity Score Matching Study.

机构信息

Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan.

Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan.

出版信息

Clin Infect Dis. 2020 Dec 17;71(10):2695-2701. doi: 10.1093/cid/ciaa734.

DOI:10.1093/cid/ciaa734

PMID:32504531

Abstract

BACKGROUND

We hypothesized that renin-angiotensin system (RAS) blockers have systemic protective effects beyond the respiratory tract and could reduce the risk of viral infections.

METHODS

We used the National Health Insurance Research Database and identified 2 study cohorts: the angiotensin receptor blocker (ARB) cohort and angiotensin-converting enzyme inhibitor (ACEI) cohort. Propensity score matching was applied at a 1:1 ratio by all associated variables to select 2 independent control cohorts for the ARB and ACEI cohorts. A Cox proportional hazards model was applied to assess the end outcome of viral infection.

RESULTS

The number of ARB and ACEI users was 20 207 and 18 029, respectively. The median age of ARB users and nonusers was 53.7 and 53.8 years, respectively. The median follow-up duration of ARB users and nonusers was 7.96 and 7.08 years; the median follow-up duration of ACEI users and nonusers was 8.70 and 8.98 years, respectively. The incidence rates of viral infections in ARB users and nonusers were 4.95 and 8.59 per 1000 person-years, respectively, and ARB users had a lower risk of viral infection than nonusers (adjusted hazard ratio [aHR], 0.53 [95% confidence interval {CI}, .48-.58]). The incidence rates of viral infections in ACEI users and nonusers were 6.10 per 1000 person-years and 7.72 per 1000 person-years, respectively, and ACEI users had a lower risk of viral infection than nonusers (aHR, 0.81 [95% CI, .74-.88]).

CONCLUSIONS

Hypertensive patients using either ARBs or ACEIs exhibit a lower risk of viral infection than nonusers.

摘要

背景

我们假设肾素-血管紧张素系统（RAS）阻滞剂具有超越呼吸道的全身保护作用，并可能降低病毒感染的风险。

方法

我们使用国家健康保险研究数据库，确定了两个研究队列：血管紧张素受体阻滞剂（ARB）队列和血管紧张素转换酶抑制剂（ACEI）队列。通过所有相关变量以 1:1 的比例进行倾向评分匹配，为 ARB 和 ACEI 队列选择了两个独立的对照组。应用 Cox 比例风险模型评估病毒感染的终末结局。

结果

ARB 和 ACEI 使用者的数量分别为 20207 人和 18029 人。ARB 使用者和非使用者的中位年龄分别为 53.7 岁和 53.8 岁。ARB 使用者和非使用者的中位随访时间分别为 7.96 年和 7.08 年；ACEI 使用者和非使用者的中位随访时间分别为 8.70 年和 8.98 年。ARB 使用者和非使用者的病毒感染发生率分别为 4.95 和 8.59/1000 人年，ARB 使用者的病毒感染风险低于非使用者（调整后的危险比[ aHR]，0.53 [95%置信区间{CI}，0.48-0.58]）。ACEI 使用者和非使用者的病毒感染发生率分别为 6.10/1000 人年和 7.72/1000 人年，ACEI 使用者的病毒感染风险低于非使用者（aHR，0.81 [95% CI，0.74-0.88]）。