从机制谈ACE/ACE2、RAS抑制剂与COVID-19的关系  

The relationship between ACE/ACE2,RAS inhibitors and COVID-19 from the mechanism

作　　者：唐欣颖 匡泽民[2] TANG Xinying;KUANG Zemin(Department of Cardiology,the First People's Hospital of Chenzhou,University of South China,Chenzhou,Hunan 423000,China;Department of Hypertension,Beijing Anzhen Hospital of Capital Medical University,Beijing 100029,China)

机构地区：[1]南华大学附属郴州市第一人民医院心血管内科,湖南省郴州市423000 [2]首都医科大学附属北京安贞医院高血压科,北京市100029

出　　处：《中国动脉硬化杂志》2020年第5期390-394,399,共6页Chinese Journal of Arteriosclerosis

基　　金：中国中青年临床研究基金(2017-CCA-VG-016);北京市卫生与健康科技成果和适宜技术推广项目(2018-TG-03);首都医科大学附属北京安贞医院院长科技发展基金(2016P01);李氏大药厂科研基金项目(2016)。

摘　　要：2019冠状病毒病(COVID-19)的发现与蔓延引起社会各界广泛关注,医学界关于血管紧张素转换酶(ACE)/ACE2、肾素-血管紧张素系统(RAS)抑制剂与COVID-19之间的关系众说纷纭。ACE和ACE2结构相似但作用相反,体内正向ACE-AngⅡ-AT1R轴和负向ACE2-Ang(1-7)-Mas轴相互制衡,维持血压及内环境的稳定。多项基础研究显示,不同RAS抑制剂对ACE2的影响不一致,尚不能明确ACE2与COVID-19的因果关系,也未发现使用RAS抑制剂有加重COVID-19的临床证据。ACE2影响COVID-19病情的考量,基本来自于RAS理论推导和SARS基础研究的结果推论。合并COVID-19的心血管疾病患者使用RAS抑制剂应结合临床实践情况并权衡利弊,不能在当前模棱两可形势下就随意停用循证医学证据充分的RAS抑制剂。Since the discovery and spread of coronavirus disease 2019(COVID-19),it has aroused widespread concern from all walks of life.There are different opinions on the relationship among angiotension converting enzyme(ACE)/ACE2,renin-angiotension system(RAS)inhibitors and COVID-19 in medical circles.ACE and ACE2 are similar in structure but have opposite effects.The positive ACE-AngⅡ-AT1R axis and the negative ACE2-Ang(1-7)-Mas axis in vivo check and balance each other to maintain the stability of blood pressure and internal environment.A number of basic studies have shown that different RAS inhibitors have inconsistent effects on ACE2.The causal relationship between ACE2 and COVID-19 has not been clarified,and no clinical evidence has been found that the use of RAS inhibitors aggravates COVID-19.The consideration of ACE2 influencing COVID-19 is basically derived from the theoretical derivation of RAS and the inference of the basic research results of SARS.Whether cardiovascular disease patients with COVID-19 use RAS inhibitors should be combined with clinical practice and weighing the pros and cons.Evidence-based RAS inhibitors cannot be arbitrarily discontinued in the current ambiguous situation.

关 键 词：COVID-19 血管紧张素转换酶2 心血管疾病 高血压 RAS抑制剂 

分 类 号：R5[医药卫生—内科学]