Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar.
J Clin Pharmacol. 2021 Aug;61(8):987-1000. doi: 10.1002/jcph.1852. Epub 2021 Apr 7.
Since the discovery of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), numerous research has been undertaken to delineate the various effects of the virus which manifests in many ways all over the body. The association between the SARS-CoV-2 invasion mechanism and the renin-angiotensin-aldosterone system (RAAS) receptors, created many debates about the possible consequences of using RAAS-modulating drugs including angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) during the pandemic. Many clinical studies were conducted to assess the outcomes of coronavirus disease 2019 (COVID-19) in patients who use ACEi/ARBs following the arguments claiming to discontinue these drugs as a precautionary measure. Although several studies mainly analyzed the outcomes of the disease, this review aimed to compare specific blood markers in both groups of COVID-19 patients to gain better insight into the interaction of ACEi/ARBs with different body functions during the infection. Several databases were searched using a combination of keywords followed by screening and data extraction. Only 28 studies met our inclusion criteria, the majority of which showed no significant difference between the inflammation markers of COVID-19 patients who used or did not use ACEi/ARBs. Interestingly, 6 studies reported lower inflammatory markers in COVID-19 patients who used ACEi/ARBs, and 6 studies reported better outcomes among the same group. We therefore concluded that the use of ACEi/ARBs may not lead to worse prognosis of COVID-19 and may even play a protective role against the hyperinflammatory response associated with COVID-19.
自严重急性呼吸综合征冠状病毒 2(SARS-CoV-2)被发现以来,已经进行了大量研究来阐明病毒在全身以多种方式表现出的各种影响。SARS-CoV-2 入侵机制与肾素-血管紧张素-醛固酮系统(RAAS)受体之间的关联,引发了许多关于在大流行期间使用 RAAS 调节药物(包括血管紧张素转换酶抑制剂(ACEi)和血管紧张素 II 受体阻滞剂(ARB))可能产生的后果的争论。进行了许多临床研究来评估在感染期间使用 ACEi/ARB 的 COVID-19 患者的结局,这些研究是基于声称要作为预防措施而停止使用这些药物的论点进行的。尽管几项研究主要分析了疾病的结局,但本综述旨在比较 COVID-19 患者两组之间的特定血液标志物,以更深入地了解 ACEi/ARB 在感染期间与不同身体功能的相互作用。使用关键词组合搜索了多个数据库,然后进行筛选和数据提取。只有 28 项研究符合我们的纳入标准,其中大多数研究表明使用或不使用 ACEi/ARB 的 COVID-19 患者的炎症标志物之间没有显著差异。有趣的是,有 6 项研究报告称使用 ACEi/ARB 的 COVID-19 患者的炎症标志物较低,而有 6 项研究报告称同一组患者的结局更好。因此,我们得出结论,使用 ACEi/ARB 可能不会导致 COVID-19 的预后更差,甚至可能在对抗与 COVID-19 相关的过度炎症反应方面发挥保护作用。
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