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肥胖与 COVID-19:影响肾素-血管紧张素系统的不祥二重奏。

Obesity and COVID-19: the ominous duet affecting the renin-angiotensin system.

机构信息

Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan, Italy -

Department of Biomedical Sciences for Health, University of Milan, Milan, Italy -

出版信息

Minerva Endocrinol (Torino). 2021 Jun;46(2):193-201. doi: 10.23736/S2724-6507.20.03402-1. Epub 2021 Jan 12.

Abstract

The world population is facing a health challenge never seen since the Spanish influenza of one hundred years ago. During the last months, the scientific community has been debating on the potential harmful effect of angiotensin-converting-enzyme inhibitors (ACEi) or angiotensin II receptor type 1 receptor blockers (AT1-receptor blockers, ARBs) during the COVID-19 pandemic. That is because the S spike protein of SARS-CoV viruses utilizes the angiotensin-converting enzyme 2 (ACE2) as a receptor to enter alveolar epithelial cells. Obesity, often associated to type 2 Diabetes, was shown to worsen the prognosis of SARS-CoV-2 infection. Herein we discuss the complex interaction between the renin-angiotensin-aldosterone system (RAAS), its receptors, and the interaction with the Kallikrein-Kinin-system (KKS) and the potential activation of the coagulation cascade. Alteration of the equilibrium between the RAAS system and the KKS cascade may explain the frequent thromboembolic complications of COVID-19 mainly seen in obese and diabetic-obese patients. In contrast, angiotensin (1-7) contributes to maintaining a correct balance between RAAS and KKS system. Our conclusion is that the higher mortality rate in patients with obesity is linked to the alteration of RAS and RAS-KKS interaction consequent to SARS-CoV-2-cell entrance. At present, no data support the necessity of modifying ACEi or ARBs treatment in hypertensive patients.

摘要

世界人口正面临着自 100 年前西班牙流感以来从未见过的健康挑战。在过去的几个月里,科学界一直在争论血管紧张素转换酶抑制剂(ACEi)或血管紧张素 II 受体 1 型受体阻滞剂(AT1-receptor blockers,ARBs)在 COVID-19 大流行期间可能产生的有害影响。这是因为 SARS-CoV 病毒的 S 刺突蛋白利用血管紧张素转换酶 2(ACE2)作为受体进入肺泡上皮细胞。肥胖症通常与 2 型糖尿病相关,被证明会使 SARS-CoV-2 感染的预后恶化。在此,我们讨论了肾素-血管紧张素-醛固酮系统(RAAS)及其受体之间的复杂相互作用,以及与激肽释放酶-激肽系统(KKS)的相互作用和凝血级联的潜在激活。RAAS 系统和 KKS 级联之间平衡的改变可能解释了 COVID-19 中经常发生的血栓栓塞并发症,这些并发症主要见于肥胖和肥胖糖尿病患者。相比之下,血管紧张素(1-7)有助于维持 RAAS 和 KKS 系统之间的正确平衡。我们的结论是,肥胖患者的死亡率较高与 SARS-CoV-2 细胞进入导致的 RAS 和 RAS-KKS 相互作用的改变有关。目前,没有数据支持需要改变高血压患者的 ACEi 或 ARBs 治疗。

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