血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂对 2019 冠状病毒病（COVID-19）临床结局的不同保护作用：系统评价和荟萃分析。
The divergent protective effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on clinical outcomes of coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis.
机构信息
Zhuzhou Central Hospital, Department of Cardiology, Zhuzhou, China.
Xuzhou Medical University, Department of Pharmacy, Xuzhou, China.
出版信息
Ann Palliat Med. 2022 Apr;11(4):1253-1263. doi: 10.21037/apm-21-972. Epub 2021 Nov 4.
BACKGROUND
Some studies have speculated that patients on angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) are more susceptible to adverse outcomes of coronavirus disease 2019 (COVID-19). Here, we performed a systematic review and meta-analysis to evaluate the safety and efficacy of administering ACEIs and ARBs to patients with COVID-19.
METHODS
Studies of COVID-19 were collected from the PubMed, Embase, medRxiv and BioRxiv databases. The pooled relative risk odds ratio (OR) and 95% confidence interval (95% CI) were calculated. Subgroup analyses were conducted by medication (ACEIs and ARBs) and geographical location (China and outside China). Inter-study heterogeneity was assessed using meta-regression. Begg's test, Egger's test and funnel plots were adopted to evaluate possible publication bias.
RESULTS
Thirty studies containing 10,434 adult patients were included in our meta-analysis. The pooled result indicated that the administration of ACEIs or ARBs reduced the risk of severe/death outcomes for COVID-19 patients. Meanwhile, a significant reduction in the risk of severe/death outcomes was observed to be associated with the administration of ACEIs or ARBs among COVID-19 patients in China, but this association was weaker for studies outside China. Furthermore, ACEI therapy was found to carry a significantly lower risk of an adverse clinical outcome.
DISCUSSION
Our systematic review and meta-analysis found that neither ACEIs nor ARBs worsen the clinical outcomes of COVID-19 patients. On the contrary, we found that patients treated with ACEIs or ARBs have a reduced risk of severe/death outcomes, especially in Asia. Furthermore, ACEIs may reduce the risk of severe/death outcomes. Therefore, treatment interruption of ACEI or ARB therapy during COVID-19 infection is not recommended.
背景
一些研究推测，血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）的患者更容易出现 2019 年冠状病毒病（COVID-19）的不良结局。在这里，我们进行了系统评价和荟萃分析，以评估 ACEI 和 ARB 对 COVID-19 患者的安全性和疗效。
方法
从 PubMed、Embase、medRxiv 和 BioRxiv 数据库中收集 COVID-19 研究。计算合并相对风险优势比（OR）和 95%置信区间（95%CI）。通过药物（ACEI 和 ARB）和地理位置（中国和中国以外）进行亚组分析。采用meta 回归评估研究间异质性。采用 Begg 检验、Egger 检验和漏斗图评估可能存在的发表偏倚。
结果
荟萃分析纳入了 30 项包含 10434 例成年患者的研究。合并结果表明，ACEI 或 ARB 的使用降低了 COVID-19 患者严重/死亡结局的风险。同时，在中国 COVID-19 患者中，ACEI 或 ARB 的使用与严重/死亡结局风险显著降低相关，但在中国以外的研究中这种相关性较弱。此外，ACEI 治疗的不良临床结局风险明显降低。
讨论
我们的系统评价和荟萃分析发现，ACEI 和 ARB 均不会使 COVID-19 患者的临床结局恶化。相反，我们发现接受 ACEI 或 ARB 治疗的患者严重/死亡结局风险降低，尤其是在亚洲。此外，ACEI 可能降低严重/死亡结局的风险。因此，不建议在 COVID-19 感染期间中断 ACEI 或 ARB 治疗。
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