Chest:肾素-血管紧张素-醛固酮系统抑制剂在肺动脉高压中的使用和对死亡率的影响

2020-10-06 MedSci原创 MedSci原创

使用ACEI/ARB与PH患者较低的死亡率相关。使用AA是PH患者疾病严重程度的标志。ACEIs/ARBs可能是多种PH表型的治疗策略。

肾素-血管紧张素-醛固酮系统(RAAS)会促进肺动脉高压(PH)的发生发展。尽管动物数据表明RAAS抑制可减轻PH,但尚不清楚RA​AS抑制对PH患者是否有益。近日,呼吸领域权威杂志chest上发表了一篇研究文章,该研究旨在明确经血液动力学确诊的PH患者使用RAAS抑制剂是否可以降低死亡率?

研究人员使用退伍军人事务部临床评估报告和跟踪数据库回顾性地分析了24221例经血液动力学证实的PH患者RAAS抑制剂(血管紧张素转换酶抑制剂[ACEIs]、血管紧张素受体阻滞剂[ARBs]和醛固酮拮抗剂[AAs])与患者死亡率之间的关系。该模型对人口统计学指标、社会经济状况、合并症、疾病严重性和联合用药进行了调整。

在整个队列和倾向匹配队列中未经调整的Kaplan-Meier生存分析表明ACEI/ARB使用与改善的生存相关。这种关系对调节不敏感,与肺动脉楔压无关,并且在仅限于毛细血管前PH患者的队列中也观察到类似结果。在整个队列未经调整的Kaplan-Meier生存分析中,AAs使用与较差的生存结局相关;然而,在倾向匹配的人群中,AA的使用与死亡率没有明显的相关性,并且对疾病严重度调整后,AA使用与PH患者更差的生存率无关。

由此可见,使用ACEI/ARB与PH患者较低的死亡率相关。使用AA是PH患者疾病严重程度的标志。ACEIs/ARBs可能是多种PH表型的治疗策略。

原始出处:

Tim Lahm.et al.Renin-Angiotensin-Aldosterone System Inhibitor Use and Mortality in Pulmonary Hypertension: Insights from the Veterans Affairs CART Database.chest.2020.https://journal.chestnet.org/article/S0012-3692(20)34851-0/fulltext

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    2020-11-20 jklm09
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    2021-09-03 Smile2680
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    2020-10-08 cmsvly
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    2020-10-06 明天jing

    肺动脉高压表面是罕见病,事实上临床上并不少见,治疗药物虽然有一些,但是整体仍然不理解,可能未来需要采用综合治疗措施。

    0

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