Relationship between angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and COVID-19 incidence or severe disease
Relationship between angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and COVID-19 incidence or severe disease
复制标题
DOI：
10.1097/hjh.0000000000002866
复制
发表时间：
2021-08-01
影响因子：
4.9
通讯作者：
Zhang, Qingpeng
中科院分区：
文献类型：
--
作者：
Tse, Gary;Zhou, Jiandong;Zhang, Qingpeng
背景资料：血管紧张素转换酶抑制剂（ACEIs）或血管紧张素受体阻滞剂（ARB）可能与COVID-19感染和不良结局的易感性较高相关。我们在病例对照设计中比较了ACEI/ARB使用和COVID-19阳性，以及COVID-19阳性患者的严重程度。研究方法：纳入于2020年1月1日至7月28日期间前往香港公立医院或门诊诊所接受COVID-19真实的时间-PCR（RT-PCR）检测的连续性患者。对COVID-19阳性和阴性患者的基线人口统计学、既往合并症、实验室检查和不同药物的使用进行了比较。COVID-19阳性患者的严重终点是28天死亡率、需要重症监护入院或插管。结果：本研究纳入了213 788例患者（COVID-19阳性：n = 2774例患者;阴性：n = 211 014例患者）。共有162名COVID-19阳性患者（5.83%）符合严重程度结局。ACEI/ARB的使用在病例组中显著高于对照组（n = 156/2774，5.62 vs. n = 6708/211014，3.17%; P < 0.0001）。COVID-19阳性和严重COVID-19疾病的显著单变量预测因素为年龄较大、Charlson评分较高、合并症、使用ACEI/ARB、降糖、降脂、抗凝和抗血小板药物以及实验室检查（比值比>1，P <0. 05）。在多变量调整后，ACEI/ARB的使用与COVID-19阳性或严重疾病之间的关系仍然显著。使用ACEI和ARB之间的COVID-19阳性率或疾病严重程度无显著差异（P > 0.05）。结论：在调整显著混杂因素后，ACEI/ARB使用与COVID-19阳性和严重疾病之间存在显著相关性。
Background: Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) may be associated with higher susceptibility of COVID-19 infection and adverse outcomes. We compared ACEI/ARB use and COVID-19 positivity in a case-control design, and severity in COVID-19 positive patients. Methods: Consecutive patients who attended Hong Kong's public hospitals or outpatient clinics between 1 January and 28 July 2020 for COVID-19 real time-PCR (RT-PCR) tests were included. Baseline demographics, past comorbidities, laboratory tests and use of different medications were compared between COVID-19 positive and negative patients. Severe endpoints for COVID-19 positive patients were 28-day mortality, need for intensive care admission or intubation. Results: This study included 213 788 patients (COVID-19 positive: n = 2774 patients; negative: n = 211 014). In total, 162 COVID-19 positive patients (5.83%) met the severity outcome. The use of ACEI/ARB was significantly higher amongst cases than controls (n = 156/2774, 5.62 vs. n = 6708/211014, 3.17%; P < 0.0001). Significant univariate predictors of COVID-19 positivity and severe COVID-19 disease were older age, higher Charlson score, comorbidities, use of ACEI/ARB, antidiabetic, lipid-lowering, anticoagulant and antiplatelet drugs and laboratory tests (odds ratio >1, P < 0.05). The relationship between the use of ACEI/ARB and COVID-19 positivity or severe disease remained significant after multivariable adjustment. No significant differences in COVID-19 positivity or disease severity between ACEI and ARB use were observed (P > 0.05). Conclusion: There was a significant relationship between ACEI/ARB use and COVID-19 positivity and severe disease after adjusting for significant confounders.