Xu Tian-Xiang, Jiang Hai-Yin, Yang Zeng-Yan
Guangxi University of Chinese Medicine, Nanning, Guangxi, China.
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Acta Neurol Belg. 2025 Feb;125(1):53-60. doi: 10.1007/s13760-024-02560-7. Epub 2024 Apr 26.
Hypertension is a recognized risk factor for Parkinson's disease (PD). The renin-angiotensin system (RAS) inhibitors are widely used to treat hypertension. However, the association of RAS inhibitor use with PD has still been an area of controversy.
Thus, we conducted a meta-analysis to investigate the relationship between RAS inhibitor use and PD. PUBMED and EMBASE databases were searched for articles published up to Oct 2023. All studies that examined the relationship between RAS inhibitor use and the incidence of PD were included.
Seven studies with total 3,495,218 individuals met our inclusion criteria for this meta-analysis. Overall, RAS inhibitor use was associated with a reduction in PD risk (OR = 0.88, 95%CI = 0.79-0.98) compared with the controls. When restricted the analysis to individuals with RAS inhibitor use indication, RAS inhibitor exposure was also associated with a decreased risk of PD (OR = 0.76, 95%CI = 0.62-0.92). Pooled results of cohort studies also did support a protective role of angiotensin converting enzyme inhibitors (ACEIs) (OR = 0.97, 95%CI = 0.89-1.07) users and angiotensin II receptor blockers (ARBs) (OR = 0.8, 95%CI = 0.63-1.02) in PD.
Overall, RAS inhibitor use as a class is associated with a reduction in PD risk. However, the findings of ACEIs and ARBs may be limited by small sample size. Future well-designed studies considering the classification by inhibitor type, duration, dose, or property of BBB penetration of RAS inhibitors are needed to clarify the contribution of these exposure parameters on the risk of PD.
高血压是帕金森病（PD）公认的危险因素。肾素-血管紧张素系统（RAS）抑制剂被广泛用于治疗高血压。然而，使用RAS抑制剂与PD之间的关联仍是一个存在争议的领域。
因此，我们进行了一项荟萃分析，以研究使用RAS抑制剂与PD之间的关系。检索了PUBMED和EMBASE数据库中截至2023年10月发表的文章。纳入所有研究使用RAS抑制剂与PD发病率之间关系的研究。
七项研究共纳入3495218名个体，符合本荟萃分析的纳入标准。总体而言，与对照组相比，使用RAS抑制剂与PD风险降低相关（OR = 0.88，95%CI = 0.79 - 0.98）。当将分析限制在有RAS抑制剂使用指征的个体时，RAS抑制剂暴露也与PD风险降低相关（OR = 0.76，95%CI = 0.62 - 0.92）。队列研究的汇总结果也确实支持血管紧张素转换酶抑制剂（ACEIs）使用者（OR = 0.97，95%CI = 0.89 - 1.07）和血管紧张素II受体阻滞剂（ARBs）使用者（OR = 0.8，95%CI = 0.63 - 1.02）在PD中的保护作用。
总体而言，作为一类药物，使用RAS抑制剂与PD风险降低相关。然而，ACEIs和ARBs的研究结果可能受样本量小的限制。未来需要设计良好的研究，考虑按抑制剂类型、持续时间、剂量或RAS抑制剂血脑屏障穿透特性进行分类，以阐明这些暴露参数对PD风险的影响。
