肾素-血管紧张素-醛固酮系统抑制剂与 COVID-19 感染或住院：一项队列研究。
Renin-Angiotensin-Aldosterone System Inhibitors and COVID-19 Infection or Hospitalization: A Cohort Study.
机构信息
Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA.
Department of Epidemiology, University of Washington, Seattle, Washington, USA.
出版信息
Am J Hypertens. 2021 Apr 20;34(4):339-347. doi: 10.1093/ajh/hpaa168.
BACKGROUND
Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may increase the risk of coronavirus disease 2019 (COVID-19) infection or affect disease severity. Prior studies have not examined risks by medication dose.
METHODS
This retrospective cohort study included people aged ≥18 years enrolled in a US integrated healthcare system for at least 4 months as of 2/29/2020. Current ACEI and ARB use was identified from pharmacy data, and the estimated daily dose was calculated and standardized across medications. COVID-19 infections and hospitalizations were identified through 6/14/2020 from laboratory and hospitalization data. We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for race/ethnicity, obesity, and other covariates.
RESULTS
Among 322,044 individuals, 826 developed COVID-19 infection. Among people using ACEI/ARBs, 204/56,105 developed COVID-19 (3.6 per 1,000 individuals) compared with 622/265,939 without ACEI/ARB use (2.3 per 1,000), yielding an adjusted OR of 0.91 (95% CI 0.74-1.12). For use of <1 defined daily dose (DDD) vs. nonuse, the adjusted OR for infection was 0.92 (95% CI 0.66-1.28); for 1 to <2 DDDs, 0.89 (95% CI 0.66-1.19); and for ≥2 DDDs, 0.92 (95% CI 0.72-1.18). The OR was similar for ACEIs and ARBs and in subgroups by age and sex. 26% of people with COVID-19 infection were hospitalized; the adjusted OR for hospitalization in relation to ACEI/ARB use was 0.98 (95% CI 0.63-1.54), and there was no association with dose.
CONCLUSIONS
These findings support current recommendations that individuals on these medications continue their use.
背景
血管紧张素转换酶抑制剂（ACEIs）和血管紧张素受体阻滞剂（ARBs）可能会增加 2019 年冠状病毒病（COVID-19）感染的风险或影响疾病严重程度。先前的研究并未检查药物剂量的风险。
方法
这项回顾性队列研究纳入了自 2020 年 2 月 29 日起在美国综合医疗保健系统中至少登记 4 个月的年龄≥18 岁的人群。从药房数据中确定当前 ACEI 和 ARB 的使用情况，并对药物进行标准化计算估计日剂量。通过实验室和住院数据确定 COVID-19 感染和住院情况至 2020 年 6 月 14 日。我们使用逻辑回归估计比值比（OR）和 95%置信区间（CI），调整种族/民族、肥胖症和其他协变量。
结果
在 322044 名个体中，有 826 人感染了 COVID-19。在使用 ACEI/ARB 的人群中，有 204/56105 人（每 1000 人中有 3.6 人）发生 COVID-19 感染，而未使用 ACEI/ARB 的 622/265939 人（每 1000 人中有 2.3 人），调整后的 OR 为 0.91（95%CI 0.74-1.12）。与不使用 ACEI/ARB 相比，使用<1 个定义日剂量（DDD）和使用 1-<2 DDD 的调整后 OR 分别为 0.92（95%CI 0.66-1.28）和 0.89（95%CI 0.66-1.19），使用≥2 DDD 的调整后 OR 为 0.92（95%CI 0.72-1.18）。ACEI 和 ARB 的 OR 相似，且在年龄和性别亚组中也相似。26%的 COVID-19 感染患者住院，使用 ACEI/ARB 与住院的调整后 OR 为 0.98（95%CI 0.63-1.54），与剂量无关。
结论
这些发现支持目前的建议，即这些药物的使用者继续使用这些药物。
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