西班牙阿尔卡拉大学Francisco J de Abajo团队近期取得新进展。他们分析了肾素-血管紧张素-醛固酮系统抑制剂和COVID-19需入院治疗的风险之间的相关性。该成果发表在2020年5月14日出版的《柳叶刀》杂志上。

肾素-血管紧张素-醛固酮系统（RAAS）抑制剂可能使个体易患重症COVID-19，但缺乏流行病学证据。自COVID-19爆发以来，研究组报告了在西班牙马德里进行的一项病例研究的结果。

研究组从马德里的7家医院中招募了1139名18岁及以上的COVID-19确诊患者，39.0％为女性，平均年龄为69.1岁，均于2020年3月1日至3月24日间入院。研究组为每位患者匹配10位对照者，性别、年龄等一般资料均无统计学差异，共11390名参与者。

与对照组相比，COVID-19患者中有心血管疾病和危险因素的比例明显更高，优势比分别为1.98和1.46。与其他抗高血压药物的使用者相比，RAAS抑制剂的使用者因COVID-19而需住院治疗的校正后优势比为0.94。

血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂均未观察到风险增加。性别、年龄和心血管风险背景并未改变RAAS抑制剂和需入院治疗的COVID-19之间的相关性，而使用RAAS抑制剂的糖尿病患者中COVID-19需入院治疗的风险降低。在COVID-19的严重程度上亦观察到相同趋势。

总之，RAAS抑制剂不会增加COVID-19需入院治疗的风险，包括致命性病例和重症监护病房的病例，无需停药。

附：英文原文

Title: Use of renin–angiotensin–aldosterone system inhibitors and risk of COVID-19 requiring admission to hospital: a case-population study

Author: Francisco J de Abajo, Sara Rodríguez-Martín, Victoria Lerma, Gina Mejía-Abril, Mónica Aguilar, Amelia García-Luque, Leonor Laredo, Olga Laosa, Gustavo A Centeno-Soto, Maria ángeles Gálvez, Miguel Puerro, Esperanza González-Rojano, Laura Pedraza, Itziar de Pablo, Francisco Abad-Santos, Leocadio Rodríguez-Maas, Miguel Gil, Aurelio Tobías, Antonio Rodríguez-Miguel, Diego Rodríguez-Puyol, D Barreira-Hernandez, P Zubiaur, E Santos-Molina, E Pintos-Sánchez, M Navares-Gómez, R M Aparicio, V García-Rosado, C Gutiérrez-Ortega, C Pérez, A Ascaso, C Elvira

Issue&Volume: 2020-05-14

Abstract: Background

Concerns have been raised about the possibility that inhibitors of the renin–angiotensin–aldosterone system (RAAS) could predispose individuals to severe COVID-19; however, epidemiological evidence is lacking. We report the results of a case-population study done in Madrid, Spain, since the outbreak of COVID-19.

Methods

In this case-population study, we consecutively selected patients aged 18 years or older with a PCR-confirmed diagnosis of COVID-19 requiring admission to hospital from seven hospitals in Madrid, who had been admitted between March 1 and March 24, 2020. As a reference group, we randomly sampled ten patients per case, individually matched for age, sex, region (ie, Madrid), and date of admission to hospital (month and day; index date), from Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria (BIFAP), a Spanish primary health-care database, in its last available year (2018). We extracted information on comorbidities and prescriptions up to the month before index date (ie, current use) from electronic clinical records of both cases and controls. The outcome of interest was admission to hospital of patients with COVID-19. To minimise confounding by indication, the main analysis focused on assessing the association between COVID-19 requiring admission to hospital and use of RAAS inhibitors compared with use of other antihypertensive drugs. We calculated odds ratios (ORs) and 95% CIs, adjusted for age, sex, and cardiovascular comorbidities and risk factors, using conditional logistic regression. The protocol of the study was registered in the EU electronic Register of Post-Authorisation Studies, EUPAS34437.

Findings

We collected data for 1139 cases and 11390 population controls. Among cases, 444 (39·0%) were female and the mean age was 69·1 years (SD 15·4), and despite being matched on sex and age, a significantly higher proportion of cases had pre-existing cardiovascular disease (OR 1·98, 95% CI 1·62–2·41) and risk factors (1·46, 1·23–1·73) than did controls. Compared with users of other antihypertensive drugs, users of RAAS inhibitors had an adjusted OR for COVID-19 requiring admission to hospital of 0·94 (95% CI 0·77–1·15). No increased risk was observed with either angiotensin-converting enzyme inhibitors (adjusted OR 0·80, 0·64–1·00) or angiotensin-receptor blockers (1·10, 0·88–1·37). Sex, age, and background cardiovascular risk did not modify the adjusted OR between use of RAAS inhibitors and COVID-19 requiring admission to hospital, whereas a decreased risk of COVID-19 requiring admission to hospital was found among patients with diabetes who were users of RAAS inhibitors (adjusted OR 0·53, 95% CI 0·34–0·80). The adjusted ORs were similar across severity degrees of COVID-19.

Interpretation

RAAS inhibitors do not increase the risk of COVID-19 requiring admission to hospital, including fatal cases and those admitted to intensive care units, and should not be discontinued to prevent a severe case of COVID-19.

DOI: 10.1016/S0140-6736(20)31030-8

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31030-8/fulltext