摘要
中国现有高血压患者约2.45亿,血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体阻滞剂(ARB)为一线抗高血压药物。血管紧张素转换酶2(ACE2)既是肾素-血管紧张素轴负反馈调节的关键酶,也是新型冠状病毒(SARS-CoV-2)感染侵入人体细胞所必需的功能受体。ACEI或ARB在降压的同时,可反射性引起ACE2表达增加;而SARS-CoV-2感染棘突蛋白(S蛋白)与ACE2结合后导致其含量减少,进而加重随后发生的肺损伤和心肌等组织损伤。本文讨论SARS-CoV-2感染是否会影响ACEI或ARB的降压效果,以及高血压患者应用ACEI或ARB反射性引起的ACE2增加是否会增加SARS-CoV-2的易感性或加重感染后肺损伤。
Right now,there are about 245 million people with hypertention in China.Blockers of the renin-angiotensin system(RAS),that is,renin inhibitors,angiotensin(Ang)-converting enzyme(ACE)inhibitors(ACEIs),and angiotensin receptor blockers(ARBs),are a cornerstone in the treatment of hypertension.ACE2 has emerged as a potent negative regulator of the RAS counterbalancing the multiple functions of ACE.By targeting angiotensin II ACE2 exhibits a protective role in the cardiovascular system and many other organs.At the same time,ACE2 was also identified as an essential receptor for the SARS coronavirus that causes severe acute lung failure.Down regulation of ACE2 strongly contributes to the pathogenesis of severe lung failure.ACEI or ARB for the treatment of hypertension may cause ACE2 increase,while SARS-CoV-2 infection with the use of spike protein binds to ACE2,resulting in downregulation through its internalization,and thus reduce the level of ACE2.In this editorial,we discuss whether SARS-CoV-2 infection would attenuate the efficacy of ACEI or ARB for the treatment of hypertension,or the reflexly increased ACE2 expression would accentuate the injury of the lung or increase the vulnerability to SARS-CoV-2?
作者
李红芳
邓勇志
LI Hongfang;DENG Yongzhi(Department of General Laboratory,Shanxi Provincial Rehabilitation and Research Center,the Disabled Rehabilitation Hospital of Shanxi Province,Taiyuan,030032,China;Department of Cardiovascular Surgery,Shanxi Cardiovascular Hospital/Institute)
出处
《临床心血管病杂志》
CAS
北大核心
2020年第3期204-208,共5页
Journal of Clinical Cardiology
作者简介
通信作者:邓勇志,E-mail:dengyongzhi@hotmail.com
