Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may be harmful in patients with diabetes during COVID-19 pandemic
Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may be harmful in patients with diabetes during COVID-19 pandemic
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DOI：
10.1016/j.dsx.2020.04.019
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发表时间：
2020-07-01
影响因子：
10
通讯作者：
Cure, Medine Cumhur
中科院分区：
文献类型：
--
作者：
Cure, Erkan;Cure, Medine Cumhur
新型冠状病毒病2019年(新冠肺炎)的爆发再次证明了肾素-血管紧张素系统(RAS)在糖尿病患者中的重要性。糖尿病患者RAS的激活增加。病毒在低胞液pH值时附着在ACE2酶上，进入细胞并引起感染。特别是在糖尿病和高血压、肥胖、老年、吸烟等并存情况下，细胞内pH较低，病毒很容易通过与ACE2结合进入细胞。血管紧张素转换酶抑制剂和血管紧张素转换酶抑制剂通过增加血管紧张素转换酶2水平而导致血管紧张素II水平降低，从而导致胞浆pH值降低。由于ACEI和ARB导致的心脏ACE2水平升高，可导致病毒容易进入心脏组织，从而引发心律失常和心肌炎。脑干延髓吻侧腹外侧区有ACE2活性。脑干中血管紧张素1-7的释放导致交感神经系统的激活。这种激活会导致全身血管收缩，患者的血压会升高。最重要的事件是中枢刺激引起的交感神经活动增加，这种活动增加了肺毛细血管渗漏，导致ARDS。由于糖尿病患者已经很低的胞浆pH值在上述机制下将进一步降低，病毒载量将增加，感染将加剧。因此，糖尿病患者使用血管紧张素转换酶抑制剂和ARB可增加新冠肺炎的发病率和死亡率。(C)2020年印度糖尿病。爱思唯尔有限公司出版，版权所有。y
The novel coronavirus disease 2019 (COVID-19) outbreak once again demonstrated the importance of the renin-angiotensin system (RAS) in patients with diabetes. Activation of the RAS increases in patients with diabetes. The virus attaches to the ACE2 enzyme at low cytosolic pH values and enters into the cell and causes infection. Especially in the presence of diabetes mellitus and accompanying comorbid conditions such as hypertension, obesity, old age, and smoking, cytosolic pH is low, thus the virus easily may enter the cell by attaching to ACE2. ACEIs and ARBs lead to a reduction in angiotensin II level by increasing the ACE2 level, thus they cause a low cytosolic pH. Increased cardiac ACE2 levels due to ACEIs and ARBs can trigger cardiac arrhythmias and myocarditis by causing the virus to easily enter the heart tissue. There is ACE2 activity in the rostral ventrolateral medulla in the brain stem. The release of angiotensin 1-7 in the brain stem leads to the activation of the sympathetic nervous system. This activation causes systemic vasoconstriction and the patient's blood pressure increases. The most important event is the increased sympathetic activity via the central stimulation, this activity increases pulmonary capillary leaking, causing the ARDS. As the cytosolic pH, which is already low in patients with diabetes will decrease further with the mechanisms mentioned above, the viral load will increase and the infection will be exacerbated. As a result, the use of ACEIs and ARBs in patients with diabetes can lead to increased morbidity and mortality of COVID-19. (C) 2020 Diabetes India. Published by Elsevier Ltd. All rights reserved.y