摘要
2019年暴发的新型冠状病毒肺炎(COVID-19),表现为新型冠状病毒(SARSCoV-2)以血管紧张素转化酶2(ACE2)为作用靶点,入侵细胞引起重症肺炎及急性呼吸窘迫综合征(ARDS)。破坏ACE2可引起血管紧张素Ⅱ(AngⅡ)表达的增高,导致全身炎症反应。AngⅡ和ACE2均是肾素-血管紧张素-醛固酮系统(RAAS)的重要调控因子,该系统失衡被证实在COVID-19发病中占重要角色。与此同时,ACE2的高表达可能有助于提高患者对SARS-CoV-2感染的耐受性。血管紧张素转化酶抑制剂及血管紧张素受体阻滞剂(ACEI/ARB)是临床常用的降压药,具有降低AngⅡ并增加ACE2水平的药学效用。研究表明,ACEI/ARB可减轻肺炎的症状并改善预后。根据上述理论和研究,笔者推测根据ACEI/ARB可降低由AngⅡ高表达所致的炎症损伤,并通过增加ACE2表达水平而提高患者对病毒感染的耐受性等作用效果,ARCI/ARB可能成为COVID-19感染控制的手段之一。
SARS-CoV-2that causes the new coronavirus pneumonia(COVID-19)invades cells by binding to angiotensin-converting enzyme 2(ACE2)and causes severe pneumonia and ARDS.Higer expression of AngⅡresulted from ACE2destroyed by SARS-CoV-2leads to a systemic inflammatory response.AngⅡand ACE2are both important regulators of the renin-angiotensin-aldosterone system(RAAS).The imbalances of RAAS has been confirmed to be one of the important pathogenesis of coronavirus pneumonia.Meanwhile,high expression of ACE2may increase patients'tolerance to SARS-CoV-2.Angiotensin converting enzyme inhibitors(ACEI)and angiotensin receptor blockers(ARB),commonly used hypotensors,can reduce the expression of AngⅡand increase the level of ACE2.Studies have shown that ACEI/ARB can reduce the symptoms and improve the prognosis of pneumonitis.Based on the theories and researches mentioned above,we speculate that ACEI/ARB may be an effective treatment of COVID-19through reducing inflammation caused by AngⅡand improving patients’tolerance of SARS-CoV-2.
作者
王仲
方奕鹏
郭喆
柴彦
Wang Zhong;Fang Yipeng;Guo Zhe;Chai Yan(Beijing Tsinghua Changgung Hospital,Tsinghua University,Beijing,China;School of Clinical Medicine,Tsinghua University,Beijing,China)
基金
国家重点研发计划(项目编号:2018YFC1705900)。
