肾素-血管紧张素-醛固酮系统抑制剂治疗新型冠状病毒肺炎合并高血压患者有效性与安全性的Meta分析

Meta Analysis of the Efficacy and Safety of Rennin-angiotensin-aldosterone System Iinhibitors in Patients with COVID-19 Associated with Hypertension

背景新型冠状病毒肺炎(COVID-19)的蔓延流行给全球生命健康及疾病防治带来了严峻挑战,COVID-19合并基础疾病患者的死亡率明显增高。肾素-血管紧张素-醛固酮系统抑制剂(RAASi)是一类重要的抗高血压药,研究发现RAASi可能增加COVID-19患者的发病率与死亡率,本研究旨在明确RAASi治疗COVID-19合并高血压患者的有效性与安全性。目的系统评价RAASi治疗COVID-19合并高血压患者的有效性与安全性。方法检索PubMed、Embase、Cochrane Library及中国知网(CNKI),检索时间为建库至2022年1月。纳入公开发表的、采用RAASi治疗与非RAASi治疗的COVID-19合并高血压患者的病例对照研究,结局指标为总体死亡率、危重症发生率、急性呼吸窘迫综合征(ARDS)发生率、心肌损伤发生率、肾损伤发生率,采用RevMan 5.3软件进行Meta分析。结果纳入的17项研究共包含5689例患者,其中2168例接受了RAASi治疗(RAASi治疗组),3521例未接受RAASi治疗(非RAASi治疗组)。Meta分析结果显示:RAASi治疗组COVID-19合并高血压患者总体死亡率低于非RAASi治疗组〔OR=0.54,95%CI(0.41,0.72),P<0.0001〕;RAASi治疗组与非RAASi治疗组COVID-19合并高血压患者危重症发生率〔OR=0.92,95%CI(0.79,1.08),P=0.30〕、ARDS发生率〔OR=0.81,95%CI(0.57,1.13),P=0.22〕、心肌损伤发生率〔OR=1.03,95%CI(0.83,1.27),P=0.82〕、肾脏损伤发生率〔OR=1.13,95%CI(0.78,1.66),P=0.52〕比较,差异均无统计学意义。结论RAASi治疗COVID-19合并高血压患者可降低总体死亡率,且不增加COVID-19合并高血压患者危重症、ARDS、心肌损伤及肾脏损伤发生率,具有较好的疗效和安全性。

Background The spreading epidemic of novel coronavirus(corona virus disease 2019,COVID-19)pneumonia poses a serious challenge to global life health and disease control,with significantly higher mortality rates among individuals infected with COVID-19 comorbid underlying disease.Inhibitors of the rennin-angiotensin-aldosterone system(RAASi),an important class of anti-hypertensive drugs,have been found to increase the morbidity and mortality of COVID-19.This study aimed to clarify the efficacy and safety of RAASi treatment in COVID-19 patients with hypertension.Objective To systematically evaluate the efficacy and safety of RAASi therapy in COVID-19 patients with hypertension.Methods PubMed,Embase,Cochrane Library and China National Knowledge Infrastructure(CNKI)were searched from inception to January 2022.A publicly available case-control studies of COVID-19 patients with hypertension treated with RAASi versus non RAASi therapy were included,and outcome measures were overall mortality,incidence of critical illness,incidence of acute respiratory distress syndrome(ARDS),incidence of myocardial injury,and incidence of renal injury,with meta-analysis performed using Revman 5.3.Results Seventeen studies with a total of 5689 patients were included,of whom 2168 received RAASi therapy and 3521 did not.Meta analysis showed that overall mortality was lower in COVID-19 comorbid hypertensive patients treated with RAASi compared with non RAASi treated patients〔OR=0.54,95%CI(0.41,0.72),P<0.0001〕;Between RAASi treated and non RAASi treated COVID-19 patients associated with hypertension,the incidence of critical illness〔OR=0.92,95%CI(0.79,1.08),P=0.30〕,the incidence of ARDS〔OR=0.81,95%CI(0.57,1.13,P=0.22〕,the incidence of myocardial injury〔OR=1.03,95%CI(0.83,1.27),P=0.82〕,and the incidence of kidney injury〔OR=1.13,95%CI(0.78,1.66),P=0.52〕,differences were not statistically significant.Conclusion Treatment with RAASi in COVID-19 patients with hypertension reduced the overall mortality rate,and did not increase the incidence of critical illness,ARDS,myocardial injury,and renal injury in COVID-19 patients with hypertension.RAASi therapy is effective and safe in treating patients with COVID-19 combined with hypertension.