Mazzoni Tony, Maraia Zaira, Ruggeri Benedetta, Polidori Carlo, Micioni Di Bonaventura Maria Vittoria, Armillei Laura, Pomilio Irene, Mazzoni Isidoro
Pharmacology Unit, School of Pharmacy, University of Camerino, 62032 Camerino, Italy.
ASUR Marche AV5, 63100 Ascoli Piceno, Italy.
J Clin Med. 2022 May 5;11(9):2580. doi: 10.3390/jcm11092580.
During the 2019 Coronavirus pandemic (COVID-19), a concern emerged regarding a possible correlation between the severe form of SARS-CoV-2 infection and administration of ACE-Inhibitors (ACE-I) and Sartans (ARB), since long-term use of these drugs may potentially result in an adaptive response with up-regulation of the ACE 2 receptor. Given the crucial role of ACE2, being the main target for virus entry into the cell, the potential consequences of ACE2 up-regulation have been a source of debate. The aim of this retrospective cohort study on COVID-19-positive patients who died is to investigate whether previous long-term exposure to ACE-I and/or ARB was associated with higher mortality due to COVID-19 infection, compared to all other types of drug treatment.
We analysed the clinical and demographic data of 615 patients hospitalized for COVID-19 at the two hospitals of the Vasta Area n.5, between March 2020 and April 2021. Among them, 86 patients, treated with ACE-Is and/0 ARBs for about 12 months, died during hospitalization following a diagnosis of acute respiratory failure. Several quantitative and qualitative variables were recorded for all patients by reading their medical records.
The logistic model showed that the variables that increase mortality are age and comorbid diseases. There were no demonstrable mortality effects with ACE-I and ARB intake.
The apparent increase in morbidity in patients with COVID-19 who received long-term treatment with ACE-I or ARB is not due to the drugs themselves, but to the conditions associated with their use.
在2019年冠状病毒大流行（COVID-19）期间，人们开始关注严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染与使用血管紧张素转换酶抑制剂（ACE-I）和沙坦类药物（ARB）之间可能存在的相关性，因为长期使用这些药物可能会导致适应性反应，使血管紧张素转换酶2（ACE2）受体上调。鉴于ACE2作为病毒进入细胞的主要靶点所起的关键作用，ACE2上调的潜在后果一直是争论的焦点。这项针对COVID-19阳性死亡患者的回顾性队列研究的目的是调查与所有其他类型的药物治疗相比，先前长期接触ACE-I和/或ARB是否与因COVID-19感染导致的更高死亡率相关。
我们分析了2020年3月至2021年4月期间在第5大区的两家医院因COVID-19住院的615例患者的临床和人口统计学数据。其中，86例接受ACE-I和/或ARB治疗约12个月的患者在被诊断为急性呼吸衰竭后于住院期间死亡。通过查阅所有患者的病历记录了若干定量和定性变量。
逻辑模型显示，增加死亡率的变量是年龄和合并症。服用ACE-I和ARB没有明显的死亡率影响。
接受ACE-I或ARB长期治疗的COVID-19患者发病率的明显增加并非由于药物本身，而是与其使用相关的状况。
