ACEI和ARB治疗COVID-19合并高血压患者的效果分析

Analysis of the efficacy of ACEI and ARB treatment in COVID-19 patients with hypertension

目的血管紧张素转换酶抑制剂(ACEI)和血管紧张素Ⅱ受体阻滞剂(ARB)治疗是否有利于合并高血压的新型冠状病毒感染(COVID-19)患者仍存在争议。该研究旨在探讨ACEI和ARB在COVID-19合并高血压患者中的治疗效果。方法采用回顾性分析方法,选择收治的COVID-19合并高血压患者,根据患者是否使用抗高血压药物ACEI或ARB治疗分为ACEI/ARB组(n=18)和非ACEI/ARB组(n=29),并根据患者的疾病严重程度分为普通型和重型患者,比较分析患者的临床特征、实验室检测结果、影像学数据、临床结局参数等资料。结果所有患者的年龄中位数为65.0岁(57.0~69.0岁),57.4%为男性,76.6%患者有明确的接触史,发病至入院的中位数时间为3.0 d(1.0~7.0 d),比较常见的临床表现为发热(74.5%)、咳嗽(48.9%)、乏力(27.7%)和咳痰(25.5%)。ACEI/ARB组和非ACEI/ARB组的临床分型比较差异无统计学意义(P>0.05),两组患者基线期的临床特征和实验室检查结果的比较均差异无统计学意义(P均>0.05)。在ACEI/ARB组和非ACEI/ARB组中,重型患者的淋巴细胞计数(LYMPH)相对低于普通型患者,乳酸脱氢酶(LDH)、C反应蛋白(CRP)、白细胞介素-6(IL-6)、降钙素原(PCT)和D-二聚体(D-dimer)都普遍高于普通型患者。在病程第15天,非ACEI/ARB组重型患者的LDH、CRP、IL-6、PCT和D-dimer水平均高于ACEI/ARB组的重型患者,但两组间的比较差异无统计学意义(P均>0.05)。非ACEI/ARB组有1例死亡患者,其余患者经过治疗均痊愈出院。所有患者中,ACEI/ARB组的发热持续时间、胸部X线计算机断层扫描(CT)改善时间均短于非ACEI/ARB组,住院时间和病毒核酸转阴时间长于非ACEI/ARB组,但比较均差异无统计学意义(P均>0.05)。普通型患者中,ACEI/ARB组的住院时间、病毒核酸转阴时间和胸部CT改善时间长于非ACEI/ARB组,但仅有病毒核酸转阴时间的比较具差异有统计学意义(P<0.05)。相反地,在重症患者中,非ACEI/ARB组的发热持续时间、住院时间、病毒核酸转阴时间和胸部CT改善时间长于ACEI/ARB组,但差异无统计学意义(P均>0.05)。结论ACEI或ARB治疗可缩短患者发热持续时间,对合并高血压的重症COVID-19患者可能有积极保护作用。

Objective The efficacy of angiotensin-converting enzyme inhibitors(ACEIs)and angiotensin II receptor blockers(ARBs)in the treatment of COVID-19 patients with hypertension remains controversial.This study aimed to explore the therapeutic effects of ACEIs and ARBs in COVID-19 patients with hypertension.Methods A retrospective analysis was conducted on COVID-19 patients with hypertension admitted to the hospital.Patients were divided into ACEI/ARB group(n=18)and non-ACEI/ARB group(n=29)based on whether they received ACEI or ARB treatment.Patients were further classified into common and severe types according to disease severity,and clinical characteristics,laboratory test results,imaging data,and clinical outcome parameters were compared and analyzed.Results The median age of all patients was 65.0 years(range:57.0-69.0 years),with 57.4%being male.76.6%of patients had a clear history of contact,and the median time from onset to admission was 3.0 days(range:1.0-7.0 days).The most common clinical manifestations were fever(74.5%),cough(48.9%),fatigue(27.7%),and sputum production(25.5%).There were no significant differences in clinical types between the ACEI/ARB group and non-ACEI/ARB group(P>0.05),and there were no significant differences in baseline clinical characteristics and laboratory test results between the two groups(P>0.05).In both groups,severe patients had lower lymphocyte counts and higher lactate dehydrogenase(LDH),C-reactive protein(CRP),interleukin-6(IL-6),procalcitonin(PCT),and D-dimer levels compared to common patients.On the 15th day of illness,severe patients in the non-ACEI/ARB group had higher LDH,CRP,IL-6,PCT,and D-dimer levels compared to those in the ACEI/ARB group,but the differences between the two groups were not significant(P>0.05).There was one death in the non-ACEI/ARB group,and the rest of the patients in both groups recovered and were discharged after treatment.Among all patients,the duration of fever and time to improvement on chest computed tomography(CT)were shorter in the ACEI/ARB group compared to the non-ACEI/ARB group,while the length of hospital stay and time to viral nucleic acid conversion were longer in the ACEI/ARB group,but these comparisons were not statistically significant(P>0.05).Among common patients,the length of hospital stay,time to viral nucleic acid conversion,and time to improvement on chest CT were higher in the ACEI/ARB group compared to the non-ACEI/ARB group,but only the time to viral nucleic acid conversion was significantly different(P<0.05).Conversely,among severe patients,the duration of fever,length of hospital stay,time to viral nucleic acid conversion,and time to improvement on chest CT were higher in the non-ACEI/ARB group compared to the ACEI/ARB group,but the differences were not statistically significant(P>0.05).Conclusion ACEI or ARB treatment may shorten the duration of fever,and may have a protective effect on severe COVID-19 patients with hypertension.