直接肾素抑制剂阿利吉仑治疗重型新型冠状病毒肺炎合并高血压患者的初步临床研究  

Preliminary clinical analysis of direct renin inhibitor aliskiren in the treatment of severe coronavirus disease 2019 patients with hypertension

作　　者：郭妍 曾葭 李强 李攀 罗凤鸣[6] 张维忠[7] 卢永昕[8] 王青[9] 张伟 曾正陪[11] 刘力生[12] Guo Yan;Zeng Jia;Li Qiang;Li Pan;Luo Fengming;Zhang Weizhong;Lu Yongxin;Wang Qing;Zhang Wei;Zeng Zhengpei;Liu Lisheng(Departments of Endocrinology,Changhai Hospital,The Second Military Medical University,Shanghai 200433,China;Deparment of Infectious Disease,Guanggu District,Hubei Province Maternal and Child Health Care Hospital,Wuhan 430200,China;Department of Aviation Disease,Naval Medical Center of PLA,The Second Military Medical University,Shanghai 200052,China;Department of Neurosurgery,Changhai Hospital,The Second Military Medical University,Shanghai 200433,China;Departments of Cardiology,Changhai Hospital,The Second Military Medical University,Shanghai 200433,China;Department of Respiratory and Critical Care Medicine,West China Hospital,Sichuan University,Chengdu 610041,China;Shanghai Institute of Hypertension,Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200025,China;Department of Cardiology,Union Hospital,Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430022,China;Division of Nephrology and Hypertension,University Hospital Lausanne(CHUV),Lausanne CH-1011,Switzerland;Department of Respiratory and Critical Care Medicine,Changhai Hospital,The Second Military Medical University,Shanghai 200433,China;Department of Endocrinology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Departments of Cardiology,Fuwai Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100037,China)

机构地区：[1]海军军医大学第一附属医院(长海医院)内分泌科,上海200433 [2]湖北省妇幼保健院光谷院区感染一科,武汉430200 [3]海军军医大学海军特色医学中心空勤科,上海200052 [4]海军军医大学第一附属医院(长海医院)神经外科,上海200433 [5]海军军医大学第一附属医院(长海医院)心血管内科,上海200433 [6]四川大学华西医院呼吸与危重症医学科,成都610041 [7]上海交通大学医学院附属瑞金医院上海市高血压研究所,200025 [8]华中科技大学同济医学院附属协和医院心内科,武汉430022 [9]瑞士洛桑大学附属CHUV医院肾脏与高血压科,洛桑CH-1011 [10]海军军医大学第一附属医院(长海医院)呼吸与危重症医学科,上海200433 [11]中国医学科学院,北京协和医学院,北京协和医院内分泌科,100730 [12]中国医学科学院,北京协和医学院,阜外心血管病医院心内科,北京100037

出　　处：《中华内科杂志》2020年第8期610-617,共8页Chinese Journal of Internal Medicine

摘　　要：目的探索直接肾素抑制剂阿利吉仑用于重型新型冠状病毒肺炎(COVID-19)合并高血压患者治疗的可行性。方法回顾性病例分析3例重型及1例危重型COVID-19合并高血压患者应用阿利吉仑降血压治疗的有效性和安全性。结果4例患者,男2例,女2例,平均年龄78岁(66~87岁),均以呼吸道症状起病,3例经新型冠状病毒(2019-nCoV)核酸或抗体检测确诊(重型),1例为临床诊断合并心功能不全(危重型)。既往高血压病诊断明确,2例服用钙离子拮抗剂(CCB),1例服用血管紧张素转换酶抑制剂(ACEI),1例服用血管紧张素Ⅱ受体拮抗剂(ARB)治疗。入院后停用ACEI或ARB,1例患者因心力衰竭采用阿利吉仑联合利尿剂治疗;3例患者用阿利吉仑联合CCB治疗,其中2例患者治疗1~2周后因血压偏低而停用CCB。在抗病毒、改善氧合的综合治疗基础上服用阿利吉仑降压治疗3~4周,4例患者血压控制满意且无不适主诉,病情好转,均已达到出院标准并已出院。结论初步临床结果显示阿利吉仑对重型COVID-19合并高血压患者的降压治疗是有效和安全的,但应增加病例数进一步做相关的临床治疗研究。Objective To explore the feasibility of direct renin inhibitor aliskiren for the treatment of severe or critical coronavirus disease 2019(COVID-19)patients with hypertension.Methods The antihypertensive effects and safety of aliskiren was retrospectively analyzed in three severe and one critical COVID-19 patients with hypertension.Results Four patients,two males and two females,with an average age of 78 years(66-87 years),were referred to hospital mainly because of respiratory symptoms.Three were diagnosed by positive novel coronavirus 2019(2019-nCoV)nucleic acid or antibody,and the critical patient with cardiac insufficiency was clinically determined.Two patients were treated with calcium channel antagonist(CCB),one with angiotensin converting enzyme inhibitor(ACEI),and one with angiotensinⅡreceptor antagonist(ARB).After admission,ACEI and ARB were discontinued,one patient with heart failure was treated by aliskiren combined with diuretic.Three patients were treated with aliskiren combined with CCB among whom two withdrew CCB due to low blood pressure after 1 to 2 weeks.Based on comprehensive treatment including antiviral and oxygenation treatment,blood pressure was satisfactorily controlled by aliskiren after three to four weeks without serious adverse events.All patients were finally discharged.Conclusion Our preliminary clinical data shows that antihypertensive effect of aliskiren is satisfactory and safe for severe COVID-19 patients complicated with hypertension.

关 键 词：新型冠状病毒肺炎 高血压 阿利吉仑 钙离子拮抗剂 血管紧张素转换酶抑制剂 血管紧张素Ⅱ受体拮抗剂 

分 类 号：R544.1[医药卫生—心血管疾病] R563.1[医药卫生—内科学]