Lim Jeong-Hoon, Jung Hee-Yeon, Choi Ji-Young, Park Sun-Hee, Kim Chan-Duck, Kim Yong-Lim, Cho Jang-Hee
Division of Nephrology, Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea.
Electrolyte Blood Press. 2020 Dec;18(2):23-30. doi: 10.5049/EBP.2020.18.2.23. Epub 2020 Dec 28.
The worldwide coronavirus disease 2019 (COVID-19) pandemic is still in progress, but much remains unknown about the disease. In this article, we review the association of hypertension or the renin-angiotensin system (RAS) with COVID-19 and the correlation between electrolyte disorders and disease severity. Underlying hypertension is likely to be associated with severe or critical COVID-19, but the relationship is not clear owing to confounding factors. Angiotensin-converting enzyme 2 (ACE2) plays an important role in the non-classical RAS pathway and binds to a receptor binding domain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The RAS blockade is known to increase ACE2 levels, but controversy remains regarding the effect of RAS blockade therapy in the course of COVID-19. Some reports have indicated a protective effect of RAS blockade on COVID-19, whereas others have reported an association of RAS blockade therapy with the occurrence of severe complications such as acute kidney injury and admission to the intensive care unit. Electrolyte disorders are not uncommon in patients with COVID-19, and severe COVID-19 has frequently shown hypokalemia, hyponatremia, and hypocalcemia. Electrolyte imbalances are caused by alteration of RAS, gastrointestinal loss, effects of proinflammatory cytokines, and renal tubular dysfunction by the invasion of SARS-CoV-2.
全球2019冠状病毒病（COVID-19）大流行仍在持续，但关于该疾病仍有许多未知之处。在本文中，我们综述了高血压或肾素-血管紧张素系统（RAS）与COVID-19的关联以及电解质紊乱与疾病严重程度之间的相关性。潜在的高血压可能与重症或危重症COVID-19相关，但由于混杂因素，这种关系尚不清楚。血管紧张素转换酶2（ACE2）在非经典RAS途径中起重要作用，并与严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的受体结合域结合。已知RAS阻断会增加ACE2水平，但关于RAS阻断疗法在COVID-19病程中的作用仍存在争议。一些报告表明RAS阻断对COVID-19有保护作用，而另一些报告则指出RAS阻断疗法与急性肾损伤和入住重症监护病房等严重并发症的发生有关。电解质紊乱在COVID-19患者中并不少见，重症COVID-19常表现为低钾血症、低钠血症和低钙血症。电解质失衡是由RAS改变、胃肠道丢失、促炎细胞因子的作用以及SARS-CoV-2入侵导致的肾小管功能障碍引起的。
