血管紧张素转换酶抑制药/血管紧张素受体阻滞药治疗与新型冠状病毒肺炎合并高血压患者预后的相关性

Association of angiotensin converting enzyme inhibitors/angiotensin receptor blockers treatment and prognosis of patients with cornavirus disease 2019 and hypertension

目的研究血管紧张素转换酶抑制药(ACEI)/血管紧张素受体阻滞药(ARB)治疗对新型冠状病毒肺炎(新冠肺炎)合并高血压患者预后的影响。方法本研究为单中心、回顾性队列研究,纳入武汉雷神山医院2020年2月17日至3月8日期间收住入院的新冠肺炎合并高血压患者共443例,随访至2020年4月1日。分为服用ACEI/ARB组共176例,未服用ACEI/ARB组(非ACEI/ARB组)共267例。分别比较两组入院临床特征,治疗用药,研究临床结局(院内死亡为主要观察指标)的影响因素。结果ACEI/ARB组院内死亡(RR=0.28,P=0.029),急性呼吸窘迫综合征(ARDS,RR=0.21,P=0.023),脓毒症休克(RR=0.68,P=0.011)的发生率低于非ACEI/ARB组。Logistic回归分析表明,以是否发生院内死亡为因变量,入院后服用ACEI/ARB类药物(OR=0.208,95%CI0.057~0.759,P=0.017),服用他汀类药物(OR=0.043,95%CI 0.012~0.929,P=0.043)与高血压合并新冠肺炎患者院内死亡呈负相关,而年龄≥65岁(OR=2.932,95%CI 1.048~8.026,P=0.040)、慢性心力衰竭(OR=9.439,95%CI 1.118~79.686,P=0.039)与院内死亡呈正相关。以是否发生ARDS为因变量,logistic回归分析表明,入院后服用ACEI/ARB类药物(OR=0.147,95%CI 0.031~0.688,P=0.015)与高血压合并新冠肺炎患者院内发生ARDS呈负相关,年龄≥65岁(OR=3.523,95%CI 1.120~11.080,P=0.031)、合并糖尿病(OR=3.935,95%CI 1.306~11.856,P=0.015)与发生ARDS呈正相关。以是否发生脓毒症休克为因变量,logistic回归分析表明,入院后服用ACEI/ARB类药物(OR=0.273,95%CI 0.083~0.893,P=0.032),服用他汀类药物(OR=0.094,95%CI 0.010~0.838,P=0.034)与高血压合并新冠肺炎患者院内发生脓毒症休克呈负相关,合并冠心病(OR=3.348,95%CI 1.099~10.198,P=0.034)、合并慢性心力衰竭(OR=13.005,95%CI 1.838~92.036,P=0.010)与发生脓毒症休克呈正相关。结论对于新冠肺炎合并高血压患者,新冠肺炎病程期间服用ACEI/ARB类药物可能与院内死亡及ARDS、脓毒症休克的发生呈负相关,对新冠肺炎合并高血压患者的预后并无不利作用。

Objective To examine the relationship between angiotensin converting enzyme inhibitors/angiotensin receptor blockers(ACEI/ARB)and the prognosis of patients suffering from cornavirus disease 2019(COVID-19)and hypertension.Methods A single-center,retrospective study was conducted in Wuhan,China.Patients with confirmed COVID-19 and hypertension admitted in Leishenshan Hospital from Feb 17 th,2020 to Mar 8 th,2020 were recruited in our study.The final date of follow up was April 1 st,2020.A total of 443 patients were included in the study,176 in ACEI/ARB group and 267 in non-ACEI/ARB group.Clinical characteristics and treatment in hospital were compared between two groups.Influence factors of clinical outcome(in-hospital death was main observation indicator)were studied.Results In ACEI/ARB group,the incidence rates of in-hospital mortality(RR=0.28,P=0.029),ARDS(RR=0.21,P=0.023)and septic shock(RR=0.68,P=0.011)were significantly lower,compared with those in non-ACEI/ARB group.Logistic regression analysis indicated that,in-hospital use of ACEI/ARB(OR=0.208,95%CI 0.057-0.759,P=0.017)and statins(OR=0.043,95%CI 0.012-0.929,P=0.043)were associated with lower in-hospital mortality,while age≥65 years(OR=2.932,95%CI 1.048-8.026,P=0.040)and chronic heart failure(OR=9.439,95%CI 1.118-79.686,P=0.039)were associated with higher in-hospital mortality.Logistic regression indicated that,in-hospital use of ACEI/ARB(OR=0.147,95%CI 0.031-0.688,P=0.015)was related to lower in-hospital mortality,while diabetes(OR=3.935,95%CI1.306-11.856,P=0.015)and older than 65 years(OR=3.523,95%CI 1.120-11.080,P=0.031)were related to higher incidence of ARDS.Logistic regression analysis indicated that in-hospital use of ACEI/ARB(OR=0.273,95%CI 0.083-0.893,P=0.032)and statins(OR=0.094,95%CI 0.010-0.838,P=0.034)were related with lower incidence of sepsis shock,while chronic heart failure(OR=13.005,95%CI 1.838-92.036,P=0.010)and coronary artery disease(OR=3.348,95%CI 1.099-10.198,P=0.034)were associated with higher incidence of sepsis shock.Conclusions In patients with COVID-19 and hypertension,in-hospital treatment of ACEI/ARB was related to lower in-hospital mortality and incidence of ARDS and sepsis shock.In-hospital treatment of ACEI/ARB had no adverse effect on prognosis of COVID-19 patients with hypertension.