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首页> 外文期刊>Journal of cardiovascular medicine >Therapy with RAS inhibitors during the COVID-19 pandemic
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Therapy with RAS inhibitors during the COVID-19 pandemic

机译：在Covid-19流行期间用Ras抑制剂治疗

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Coronavirus disease 2019 (COVID-19) is caused by the novel coronavirus first identified in Wuhan, China. The global number of confirmed cases of COVID-19 has surpassed 28,285,700 with mortality that appears higher than for seasonal influenza. About 20% of COVID-19 patients have experienced cardiac involvement and myocardial infarction in patients infected with SARS-CoV-2 had a worse prognosis. Furthermore, the widespread use of antiviral drugs can be linked to a worsening of heart function. Arrhythmias and hypertension have also been reported in patients with Covid-19. On the other hand, previous cardiac diseases are present in 30% of patients infected with SARS-CoV-2. There is uncertainty in the use of ace inhibitors and angiotensin II (Ang II) antagonists in the COVID-19 era. The mechanism of action of SARS-CoV-2 has been elucidated. It has been demonstrated that angiotensin-converting enzyme 2 (ACE2) is the cellular receptor for the new coronavirus SARS-CoV-2 and it is required for host cell entry and subsequent viral replication. The effect of the SARS-CoV-2 infection is the downregulation of ACE2 that may contribute to the severity of lung pathologies as well as the cardiac function. ACE2, a homolog of ACE, is a monocarboxypeptidase that converts Ang II into angiotensin 1–7 (Ang 1–7) that with its vasodilatory, antifibrotic, antihypertrophic effects counterbalances the negative effects of Ang II. On the other hand, angiotensin-converting enzyme inhibitors (ACEi) and AT1R blockers have been shown to upregulate the expression of ACE2. Based on the mechanism of action of SARS-CoV-2, the use of renin angiotensin system (RAS) inhibitors was questioned although all scientific societies did not recommend discontinuation when clinically recommended. The BRACE CORONA, a phase 4, randomized study tested two strategies: temporarily stopping the ACE inhibitor/angiotensin receptor blockers (ARB) for 30?days versus continuing ACE inhibitors/ARBs in patients who were taking these medications chronically and were hospitalized with a confirmed diagnosis of COVID-19 was also discussed. Therefore, the goal of this review is to summarize recent laboratory and clinical investigations concerning the use of ACEi and ARBs during the COVID-19 pandemic. The available data, based also on a randomized trial, suggest that ACEIs or ARBs, when clinically indicated, should be regularly used in the COVID-19 era.
机译：冠状病毒病2019（COVID-19）是由在中国武汉首次鉴定的新型冠状病毒引起的。COVID2019冠状病毒疾病的确诊病例全球死亡率超过28285700，死亡率高于季节性流感。约20%的2019冠状病毒疾病患者有心脏受累，而心肌梗死患者的SALS COV-2感染预后较差。此外，抗病毒药物的广泛使用可能与心功能恶化有关。COVID2019冠状病毒疾病也有心律失常和高血压。另一方面，30%的SARS-CoV-2感染者存在既往心脏疾病。在COVID-19时代，ACE抑制剂和angiotensin II（Ang II）拮抗剂的使用存在不确定性。SARS-CoV-2的作用机制已经阐明。已经证明，血管紧张素转换酶2（ACE2）是新冠状病毒SARS-CoV-2的细胞受体，是宿主细胞进入和随后病毒复制所必需的。SARS-CoV-2感染的影响是ACE2的下调，这可能会导致肺部病变的严重程度以及心脏功能的恶化。ACE的同系物ACE2是一种单羧肽酶，可将血管紧张素II转化为血管紧张素1-7（Ang 1-7），其血管舒张、抗纤维化、抗肥大作用可抵消Ang II的负面作用。另一方面，血管紧张素转换酶抑制剂（ACEi）和AT1R阻滞剂可上调ACE2的表达。基于SARS-CoV-2的作用机制，人们对肾素-血管紧张素系统（RAS）抑制剂的使用提出了质疑，尽管所有科学协会都不建议在临床推荐时停用。BRACE CORONA是一项4期随机研究，测试了两种策略：暂时停止ACE抑制剂/血管紧张素受体阻滞剂（ARB）30天？还讨论了那些2019冠状病毒疾病的患者与慢性病患者服用ACE抑制剂/ ARB的持续时间和确诊的COVID-19的住院时间。因此，2019冠状病毒疾病的研究和临床研究的目的是总结ACEi和ARB在COVID-19流行病中的应用。基于随机试验的2019冠状病毒疾病的临床资料表明，ACEIs或ARBS在临床上应在COVID-19时期被经常使用。

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