在一项随机对照试验中，新冠病毒病患者停用肾素-血管紧张素系统抑制剂并未改变全身血管紧张素转换酶2水平。
Renin-angiotensin system inhibitor discontinuation in COVID-19 did not modify systemic ACE2 in a randomized controlled trial.
作者信息
Rathkolb Vincent, Traugott Marianna T, Heinzel Andreas, Poglitsch Marko, Aberle Judith, Eskandary Farsad, Abrahamowicz Agnes, Mueller Martin, Knollmueller Petra, Shoumariyeh Tarik, Stuflesser Jasmin, Seeber Ivan, Gibas Georg, Mayfurth Hannah, Tinhof Viktoria, Schmoelz Lukas, Zeitlinger Markus, Schoergenhofer Christian, Jilma Bernd, Genser Bernd, Hoepler Wolfgang, Omid Sara, Karolyi Mario, Wenisch Christoph, Oberbauer Rainer, Zoufaly Alexander, Hecking Manfred, Reindl-Schwaighofer Roman
机构信息
Department of Internal Medicine III, Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Wien, Austria.
Department of Internal Medicine IV with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria.
出版信息
iScience. 2023 Oct 5;26(11):108146. doi: 10.1016/j.isci.2023.108146. eCollection 2023 Nov 17.
Despite the similar clinical outcomes after renin-angiotensin system (RAS) inhibitor (RASi) continuation or withdrawal in COVID-19, the effects on angiotensin-converting enzyme 2 (ACE2) and RAS metabolites remain unclear. In a substudy of the randomized controlled Austrian Corona Virus Adaptive Clinical Trial (ACOVACT), patients with hypertension and COVID-19 were randomized 1:1 to either RASi continuation (n = 30) or switch to a non-RASi medication (n = 29). RAS metabolites were analyzed using a mixed linear regression model (n = 30). Time to a sustained clinical improvement was equal and ACE2 did not differ between the groups but increased over time in both. Overall ACE2 was higher with severe COVID-19. ACE-S and Ang II levels increased as expected with ACE inhibitor discontinuation. These data support the safety of RASi continuation in COVID-19, although RASi were frequently discontinued in our post hoc analysis. The study was not powered to draw definite conclusions on clinical outcomes using small sample sizes.
尽管在新冠肺炎患者中继续或停用肾素-血管紧张素系统（RAS）抑制剂（RASi）后的临床结果相似，但对血管紧张素转换酶2（ACE2）和RAS代谢产物的影响仍不清楚。在奥地利冠状病毒适应性临床试验（ACOVACT）的一项随机对照子研究中，患有高血压和新冠肺炎的患者按1:1随机分为继续使用RASi组（n = 30）或改用非RASi药物组（n = 29）。使用混合线性回归模型分析RAS代谢产物（n = 30）。两组实现持续临床改善的时间相同，ACE2水平无差异，但两组均随时间增加。总体而言，重症新冠肺炎患者的ACE2水平更高。停用ACE抑制剂后，ACE-S和Ang II水平如预期升高。这些数据支持在新冠肺炎患者中继续使用RASi的安全性，尽管在我们的事后分析中RASi经常被停用。该研究样本量小，无法就临床结果得出明确结论。
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