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血管紧张素转换酶抑制剂(ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)与钙通道阻滞剂(CCB)对武汉高血压合并 COVID-19 患者进展的疗效:一项基于医院的回顾性队列研究。

Efficacy of ACEIs/ARBs vs CCBs on the progression of COVID-19 patients with hypertension in Wuhan: A hospital-based retrospective cohort study.

机构信息

Department of Pharmacy, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.

State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

J Med Virol. 2021 Feb;93(2):854-862. doi: 10.1002/jmv.26315. Epub 2020 Oct 5.

Abstract

To evaluate the efficacy of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) vs calcium channel blockers (CCBs) on the progression of Corona Virus Disease 2019 (COVID-19) patients with hypertension in Wuhan. This retrospective single-center case series analyzed COVID-19 patients with hypertension, treated with ACEIs/ARBs or CCBs at the Tongji Hospital of Wuhan City, China from 25th January to 15th March 2020. After propensity score matching analysis, 76 patients were selected into two groups. Univariate and multivariable analyses were conducted to determine factors related to improvement measures and outcome measures by Cox proportional hazard regression models. Among 157 patients with confirmed COVID-19 combined hypertension, including 73 males and 84 females, a median age of 67.28 ± 9.11 vs 65.39 ± 10.85 years. A univariable analysis indicated that clinical classification, lymphocyte count, and interleukin-2 receptor were associated with a lengthened negative time of nucleic acid, with a significant difference between two groups (P = .036). Furthermore, we found no obvious difference in nucleic acid conversion time between ACEIs/ARBs and CCBs groups (hazard ratio [HR]: 0.70; 95% confidence interval [CI]: [0.97, 3.38]; P = .18) in the multivariable analysis as well as chest computed tomography improved time (HR: 0.73; 95% CI [0.45, 1.2]; P = .87), and hospitalization time between ACEIs/ARBs and CCBs groups (HR: 1.06; 95% CI [0.44, 1.1]; P = .83). Our study provided additional evidence of no obvious difference in progress and prognosis between ACEIs/ACEIs and CCBs group, which may suggest ACEIs/ARBs may have scarcely influence on increasing the clinical severe situations of COVID-19 patients with hypertension.

摘要

评估血管紧张素转换酶抑制剂(ACEI)和血管紧张素受体阻滞剂(ARB)与钙通道阻滞剂(CCB)在武汉 COVID-19 高血压患者中的进展效果。本回顾性单中心病例系列分析了 2020 年 1 月 25 日至 3 月 15 日在中国武汉市同济医院接受 ACEI/ARB 或 CCB 治疗的 COVID-19 合并高血压患者。经过倾向评分匹配分析,选择了 76 名患者进入两组。采用 Cox 比例风险回归模型进行单变量和多变量分析,确定与改善措施和结局措施相关的因素。在 157 名确诊 COVID-19 合并高血压的患者中,包括 73 名男性和 84 名女性,中位年龄为 67.28±9.11 岁 vs 65.39±10.85 岁。单变量分析表明,临床分类、淋巴细胞计数和白细胞介素-2 受体与核酸阴性时间延长有关,两组之间有显著差异(P=0.036)。此外,多变量分析中,ACEI/ARB 与 CCB 两组之间的核酸转换时间无明显差异(风险比 [HR]:0.70;95%置信区间 [CI]:[0.97,3.38];P=0.18),以及胸部 CT 改善时间(HR:0.73;95% CI [0.45,1.2];P=0.87)和 ACEI/ARB 与 CCB 两组之间的住院时间(HR:1.06;95% CI [0.44,1.1];P=0.83)。我们的研究提供了额外的证据,表明 ACEI/ARB 与 CCB 组在进展和预后方面没有明显差异,这可能表明 ACEI/ARB 对 COVID-19 高血压患者的临床严重程度几乎没有影响。

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