Renin-angiotensin system blockade in the COVID-19 pandemic.
Renin-angiotensin system blockade in the COVID-19 pandemic.
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DOI：
10.1093/ckj/sfab026
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发表时间：
2021-03
影响因子：
4.6
通讯作者：
Sparks MA
中科院分区：
文献类型：
--
作者：
Cohen JB;South AM;Shaltout HA;Sinclair MR;Sparks MA
在2019冠状病毒病（COVID-19）大流行的最初几个月，出现了一种假设，表明肾素-血管紧张素系统（RAS）的药物抑制剂可能会增加COVID-19的严重程度。这一假设是基于血管紧张素转换酶2（ACE 2）的作用，RAS的反调节成分，作为严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的结合位点，允许病毒进入宿主细胞。根据先前证据的推断，推测RAS阻断上调ACE 2可能会增加COVID-19不良结局的风险。然而，相反的论点指出，ACE 2和RAS阻断剂对急性肺损伤具有潜在保护作用的证据，以及停用这些常用和重要药物的重大风险。在这里，我们提供了经典RAS生理学和ACE 2在受COVID-19影响的系统性途径中的关键作用的概述。此外，我们严格审查了围绕RAS阻断和COVID-19之间相互作用的生理学和流行病学证据。我们回顾了最近发表的试验证据，并提出了重要的未来方向，以提高我们对这些关系的理解。
In the early months of the coronavirus disease 2019 (COVID-19) pandemic, a hypothesis emerged suggesting that pharmacologic inhibitors of the renin–angiotensin system (RAS) may increase COVID-19 severity. This hypothesis was based on the role of angiotensin-converting enzyme 2 (ACE2), a counterregulatory component of the RAS, as the binding site for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), allowing viral entry into host cells. Extrapolations from prior evidence led to speculation that upregulation of ACE2 by RAS blockade may increase the risk of adverse outcomes from COVID-19. However, counterarguments pointed to evidence of potential protective effects of ACE2 and RAS blockade with regard to acute lung injury, as well as substantial risks from discontinuing these commonly used and important medications. Here we provide an overview of classic RAS physiology and the crucial role of ACE2 in systemic pathways affected by COVID-19. Additionally, we critically review the physiologic and epidemiologic evidence surrounding the interactions between RAS blockade and COVID-19. We review recently published trial evidence and propose important future directions to improve upon our understanding of these relationships.
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影响因子：
4.9
作者：
Cohen JB;D'Agostino McGowan L;Jensen ET;Rigdon J;South AM
通讯作者：
South AM
DOI：
10.1097/ede.0000000000000504
发表时间：
2016-09
期刊：
Epidemiology (Cambridge, Mass.)
影响因子：
--
作者：
Arnold BF;Ercumen A;Benjamin-Chung J;Colford JM Jr
通讯作者：
Colford JM Jr
DOI：
10.1016/s2213-2600(20)30558-0
发表时间：
2021-03
期刊：
The Lancet. Respiratory medicine
影响因子：
--
作者：
Cohen JB;Hanff TC;William P;Sweitzer N;Rosado-Santander NR;Medina C;Rodriguez-Mori JE;Renna N;Chang TI;Corrales-Medina V;Andrade-Villanueva JF;Barbagelata A;Cristodulo-Cortez R;Díaz-Cucho OA;Spaak J;Alfonso CE;Valdivia-Vega R;Villavicencio-Carranza M;Ayala-García RJ;Castro-Callirgos CA;González-Hernández LA;Bernales-Salas EF;Coacalla-Guerra JC;Salinas-Herrera CD;Nicolosi L;Basconcel M;Byrd JB;Sharkoski T;Bendezú-Huasasquiche LE;Chittams J;Edmonston DL;Vasquez CR;Chirinos JA
通讯作者：
Chirinos JA
影响因子：
9
作者：
Channappanavar R;Perlman S
通讯作者：
Perlman S
影响因子：
19.6
作者：
Bürgelová, M;Kramer, HJ;Cervenka, L
通讯作者：
Cervenka, L