COVID-19合并高血压患者应用ACEI或ARB类药物的临床观察

Clinical Observation of the Application of ACEI or ARB Drugs in Patients with COVID-19 and Hypertension

摘要: 目的：观察COVID-19合并高血压患者应用ACEI或ARB类药物的临床疗效。方法：回顾性调查于2020-02-10日至2020-02-29日收治在武汉同济医院光谷院区重症病房的200例患者的病历资料，分析统计其病例的临床资料、辅助检查及治疗方案。根据是否应用ACEI/ARB类药物进行分组，分为两组：ACEI/ARB类药物组和非ACEI/ARB类药物组(应用其他降压药物，如CCB、β受体阻滞剂、利尿剂等)。观察两组实验室检查结果(CRP、IL-6、白细胞计数、淋巴细胞计数、乳酸脱氢酶、肿瘤坏死因子-α、IgM)、核酸转阴时间、出现症状–入院时间、发病–出院时间。结果：① 性别、年龄及高血压分级ACEI/ARB组与及非ACEI/ARB组无明显差异。② 12例非ACEI/ARB组患者(48%)属于严重亚组，5例死亡。相反，在ACEI/ARB组中，5例(31.25%)属于严重亚组，5死亡。严重病例在非ACEI/ARB组的百分比高于ACEI/ARB组，但这一差异并不明显，可能是由于临床病例较少。③ ACEI/ARB组患者TNF-α及乳酸脱氢酶下降明显。其他实验室检查结果，如淋巴细胞计数、高敏C反应蛋白、IL-6、淋巴细胞比例、肌酸激酶，在两组之间无显著差异。④ 两组药物对高血压COVID-19患者疗效来看，ACEI或ARB用药影响系数为0.0989011，非ACEI或ARB用药影响系数为0.2142857，标准差分别为0.1975986和0.1423602，P值分别为0.619和0.139，说明两组药物都有助于高血压新冠肺炎患者病情好转，但临床表现需要一定时间，同时ACEI或ARB用药效果略微高于非ACEI或ARB用药，但差异不是很大。结论：研究结果支持高血压COVID-19患者服用RAAS系统抑制剂。ACEI/ARB类药物改善临床转归的机制还需进一步研究。

Abstract: Objective: To observe the clinical efficacy of ACEI or ARB drugs in patients with COVID-19 and hypertension. Methods: Retrospectively investigate the medical records of 200 patients who were admitted to the intensive care unit of the Optics Valley Hospital of Wuhan Tongji Hospital from 2020-02-10 to 2020-02-29, and analyze and count the clinical data, auxiliary examinations and treatment plans of their cases. According to whether ACEI/ARB drugs are used or not, they are divided into two groups: ACEI/ARB drug group and non-ACEI/ARB drug group (application of other antihypertensive drugs, such as CCB, beta blockers, diuretic Agent, etc.). Observe the results of two groups of laboratory tests (CRP, IL-6, white blood cell count, lymphocyte count, lactate dehydrogenase, tumor necrosis factor-α, IgM), time of nucleic acid conversion, symptoms-admission time, onset-discharge time. Results: ① There was no significant difference between the ACEI/ARB group and the non-ACEI/ARB group in gender, age and hypertension classification. ② 12 patients (48%) in the non-ACEI/ARB group belonged to the severe subgroup, and 5 died. In contrast, in the ACEI/ARB group, 5 patients (31.25%) belonged to the severe subgroup and 5 died. The percentage of severe cases in the non-ACEI/ARB group is higher than that in the ACEI/ARB group, but this difference is not significant, which may be due to fewer clinical cases. ③ The TNF-α and lactate dehydrogenase decreased significantly in the ACEI/ARB group. Other laboratory test results, such as lymphocyte count, high sensitivity C-reactive protein, IL-6, lymphocyte ratio, and creatine kinase, were not significantly different between the two groups. ④ In terms of the efficacy of the two groups of drugs on patients with hypertension and COVID-19, the coefficient of influence of ACEI or ARB medication is 0.0989011, and the coefficient of influence of non-ACEI or ARB medication is 0.2142857, with standard deviations of 0.1975986 and 0.1423602, and P values of 0.619 and 0.139, it shows that the two groups of drugs can help patients with hypertension and new coronary pneumonia to improve, but the clinical manifestations take a certain time. At the same time, the effect of ACEI or ARB medication is slightly higher than that of non-ACEI or ARB medication, but the difference is not very large. Conclusion: The research results support the use of RAAS system inhibitors for patients with hypertension and COVID-19. The mechanism of ACEI/ARB drugs to improve clinical outcome needs further study.