血管紧张素转换酶抑制剂/血管紧张素受体Ⅱ拮抗剂对新型冠状病毒肺炎合并高血压患者临床特征的影响  

Effects of angiotensin converting enzyme inhibitor/angiotensin receptor blocker on clinical characteristics of coronavirus disease 2019 patients with hypertension

作　　者：黄威 李涛[1] 凌云[2] 钱志平[3] 张宇一[3] 黄丹[4] 徐水保 刘旭晖[1] 夏露[1] 杨杨 卢水华[1] 卢洪洲[5] Huang Wei;Li Tao;Ling Yun;Qian Zhiping;Zhang Yuyi;Huang Dan;Xu Shuibao;Liu Xuhui;Xia Lu;Yang Yang;Lu Shuihua;Lu Hongzhou(Department of Tuberculosis,Shanghai Public Health Clinical Center,Fudan University,Shanghai 201508,China;Deparment of Infectious Disease,Shanghai Public Health Clinical Center,Fudan University,Shanghai 201508,China;Department of Severe Hepatology,Shanghai Public Health Clinical Center,Fudan University,Shanghai 201508,China;Department of Hepatobiliary Disease,Shanghai Public Health Clinical Center,Fudan University,Shanghai 201508,China;Department of Infection and Immunology,Shanghai Public Health Clinical Center,Fudan University,Shanghai 201508,China)

机构地区：[1]上海市公共卫生临床中心结核科,201508 [2]上海市公共卫生临床中心感染科,201508 [3]上海市公共卫生临床中心重症肝病科,201508 [4]上海市公共卫生临床中心肝胆内科,201508 [5]上海市公共卫生临床中心感染与免疫科,201508

出　　处：《中华内科杂志》2020年第9期689-694,共6页Chinese Journal of Internal Medicine

基　　金：复旦大学一流大学和一流学科建设项目(IDF162005);上海市公共卫生临床中心新型冠状病毒"2019-nCoV"科研攻关院内专项课题(2020YJKY01)。

摘　　要：目的分析血管紧张素转换酶抑制剂/血管紧张素受体Ⅱ拮抗剂(ACEI/ARB)对新型冠状病毒肺炎(COVID-19)患者临床特征的影响,为COVID-19合并高血压患者降压药物的选择提供依据。方法收集2020年1月20日至2月22日上海市公共卫生临床中心58例COVID-19合并高血压患者的临床资料。根据服用抗高血压药物的情况,将患者分为ACEI/ARB组和非ACEI/ARB组,比较两组流行病学、临床表现、实验室及影像学表现,病程转归及预后的差异。结果ACEI/ARB组患者26例,非ACEI/ARB组32例;两组中位年龄[64.0(49.5,72)岁比64.0(57.0,68.8)岁]、发病时间[5(3,8)d比4(3,7)d]、入院时重症/危重症比例(19.2%比15.6%)、病情恶化(15.4%比9.4%)和好转出院(92.3%比96.9%)差异无统计学意义(P值均>0.05);两组患者症状均以发热、咳嗽为主,两组均存在淋巴细胞计数低,C反应蛋白高,乳酸脱氢酶及D-二聚体大部分正常,胸部CT以双侧受累为主。与非ACEI/ARB组相比,ACEI/ARB组肌酐较高[80.49(68.72,95.30)μmol/L比71.29(50.98,76.98)μmol/L,P=0.007],差异有统计学意义。结论ACEI/ARB对COVID-19合并高血压患者的临床基线(肌酐、肌红蛋白除外)、转归及预后无明显影响,这类患者在入院时降压药物暂可不用调整,但ACEI/ARB潜在、功能性的升高血肌酐需要引起临床医生关注。Objective To analyze the effects of angiotensin converting enzyme inhibitor/angiotensin receptor blocker(ACEI/ARB)on coronavirus disease 2019(COVID-19)patients with hypertension,and to provide an evidence for selecting antihypertensive drugs in those patients.Methods Clinical data were retrospectively analyzed in 58 COVID-19 patients with hypertension admitted to Shanghai Public Health Clinical Center from January 20 to February 22,2020,including epidemiological history,clinical manifestations,laboratory findings,chest CT and outcome.Patients were divided into ACEI/ARB group and non-ACEI/ARB group.Results Twenty-six patients were in ACEI/ARB group and the other 32 patients in non-ACEI/ARB group,with median age 64.0(49.5,72.0)years and 64.0(57.0,68.8)years respectively.The median time to onset was 5(3,8)days in ACEI/ARB group and 4(3,7)days in non-ACEI/ARB group,the proportion of patients with severe or critical illness was 19.2%and 15.6%respectively.The main clinical symptoms in two groups were fever(80.8%vs.84.4%)and cough(23.1%vs.31.3%).The following parameters were comparable including lymphocyte counts,C-reactive protein,lactate dehydrogenase,D-dimer,bilateral involvement in chest CT(76.9%vs.71.9%),worsening of COVID-19(15.4%vs.9.4%),favorable outcome(92.3%vs.96.9%)between ACEI/ARB group and non-ACEI/ARB group respectively(all P>0.05).However,compared with non-ACEI/ARB group,serum creatinine[80.49(68.72,95.30)μmol/L vs.71.29(50.98,76.98)μmol/L,P=0.007]was higher significantly in ACEI/ARB group.Conclusions ACEI/ARB drugs have no significant effects on baseline clinical parameters(serum creatine and myoglobin excluded),outcome,and prognosis of COVID-19 patients with hypertension.Antihypertensive drugs are not suggested to adjust in those patients,but the potential impairment of renal function as elevation of serum creatinine should be paid attention in patients administrating ACEI/ARB drugs.

关 键 词：新型冠状病毒肺炎 血管紧张素转换酶抑制剂 血管紧张素受体Ⅱ拮抗剂 临床特征 

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