Effect of Renin-Angiotensin System Blockage in Patients with Acute Respiratory Distress Syndrome: A Retrospective Case Control Study
Effect of Renin-Angiotensin System Blockage in Patients with Acute Respiratory Distress Syndrome: A Retrospective Case Control Study
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DOI：
10.4266/kjccm.2016.00976
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发表时间：
2017-05-01
影响因子：
1.8
通讯作者：
Lee, Sang-Min
中科院分区：
文献类型：
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作者：
Kim, Joohae;Choi, Sun Mi;Lee, Sang-Min
背景：急性呼吸窘迫综合征（ARDS）是一种严重威胁生命的疾病。许多患有ARDS的患者不能完全恢复，并且进展到终末肺纤维化。已知血管紧张素转换酶（ACE）抑制剂调节神经激素系统以减少炎症并防止组织纤维化。然而，ACE抑制剂在肺中的作用还不清楚。因此，我们进行了这项研究，以阐明肾素-血管紧张素系统（RAS）阻断对患者的预后ARDS.Methods的影响：我们分析了2005年1月至2010年12月在三级医院的重症监护室（ICU）收治的患者的病历。使用柏林定义确定ARDS。主要结局为ICU死亡率。结果：共纳入182例患者。37例患者（20.3%）在ICU住院期间服用ACE抑制剂或血管紧张素受体阻滞剂（ARB），145例（79.7%）未服用;两组的严重程度评分相似。在ICU中，RAS抑制剂组和非RAS抑制剂组的死亡率分别为45.9%和58.6%（P = 0.166）。RAS抑制剂组需要更长的机械通气时间（29.5 vs. 19.5，P = 0.013）和更长的ICU停留时间（32.1 vs. 20.2天，P < 0.001）。在生存分析中，RAS抑制剂组的生存率明显高于非RAS组（P < 0.001）。
Background: Acute respiratory distress syndrome (ARDS) remains a life-threatening disease. Many patients with ARDS do not recover fully, and progress to terminal lung fibrosis. Angiotensin-converting enzyme (ACE) inhibitor is known to modulate the neurohormonal system to reduce inflammation and to prevent tissue fibrosis. However, the role of ACE inhibitor in the lungs is not well understood. We therefore conducted this study to elucidate the effect of renin-angiotensin system (RAS) blockage on the prognosis of patients with ARDS.Methods: We analyzed medical records of patients who were admitted to the medical intensive care unit (ICU) at a tertiary care hospital from January 2005 to December 2010. ARDS was determined using the Berlin definition. The primary outcome was the mortality rate of ICU. Survival analysis was performed after adjustment using propensity score matching.Results: A total of 182 patients were included in the study. Thirty-seven patients (20.3%) took ACE inhibitor or angiotensin receptor blocker (ARB) during ICU admission, and 145 (79.7%) did not; both groups showed similar severity scores. In the ICU, mortality was 45.9% in the RAS inhibitor group and 58.6% in the non-RAS inhibitor group (P = 0.166). The RAS inhibitor group required a longer duration of mechanical ventilation (29.5 vs. 19.5, P = 0.013) and longer ICU stay (32.1 vs. 20.2 days, P < 0.001). In survival analysis, the RAS inhibitor group showed better survival rates than the non-RAS group (P < 0.001).Conclusions: ACE inhibitor or ARB may have beneficial effect on ARDS patients.