精“英”克糖丨高血压、糖尿病患者感染COVID-19的风险是否增加?

2020-12-27 00:12:25

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2020年初，新冠肺炎疫情来势汹汹。中国的科研工作者在国内疫情爆发初期获取了很多珍贵的一手资料，并发表了大量有价值的文章。高血压和糖尿病患者与COVID-19感染风险之间有无关系？这是众多医务工作者和患者共同关注的问题。瑞士巴塞尔大学医院的Michael Roth教授，通过分析已发表的中国数据，于2020年3月份撰写了一篇通信文章，表达了自己的观点。当然，其观点在发表之后引发一阵热议。为此阿宾顿-杰弗森健康中心的Neil Skolnik博士和John J. Russell博士在收集各方意见后，阐述了他们的看法。

Michael Roth教授

瑞士巴塞尔大学医院

双语字幕

For our next article, we're going to go over an article that received an incredible amount of attention on social media and on TV. And that was just a letter to the editor in Lancet two weeks ago, week and a half ago, titled “Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?”

接下来，我们将回顾一篇在社交媒体和电视上备受关注的文章。这只是两周前（一周半之前）写给Lancet杂志编辑的一封信，标题是“高血压和糖尿病患者是否会增加感染COVID-19的风险？”

What the articles said or what this letter said was that the most distinctive comorbidities of 32 non-survivors from a group of 52 intensive care unit patients with COVID-19 were cerebrovascular diseases and diabetes. And the author then went on said the most frequent comorbidities were often treated with ACE inhibitors.

这封信说的是，在52例重症监护病房的COVID-19患者中，32例死亡病例最明显的共病是脑血管疾病和糖尿病。作者接着说这些最常见的共病通常是使用血管紧张素转换酶抑制剂（ACEIs）的患者。

They then went on to describe some basic research findings regarding acquisition of COVID-19 and how COVID-19 binds to the target cells through angiotensin-converting enzyme 2 receptor sites. Those receptive sites, it turns out, are expressed in epithelial cells of the lung, intestine and blood vessels. And they went on to say the expression of ACE2 rectors is increased in patients with diabetes who are treated with ACE inhibitor or ARBs.

接着，他们介绍了COVID-19获得的一些基础研究成果，以及COVID-19如何通过血管紧张素转换酶2受体位点与靶细胞结合。事实证明，这些位点在肺、肠和血管的上皮细胞中表达。而在接受ACEIs或血管紧张素受体拮抗剂治疗的糖尿病患者中，ACE2受体的表达增加。

In addition, they are increased in patients treated with certain anti-inflammatory agents like NSAIDs. They also can be increased by TZDs. And then they suggested that ACE2 expression is increased in diabetes and some other diseases because of those medicines. And they hypothesized that diabetes and hypertension treatment with ACE inhibitor or ACE-stimulating drugs, such as ACEI or ARBs, and anti-inflammatories increases the risk of developing severe and fatal COVID-19.

此外，在使用某些抗炎药物（如非甾体抗炎药）治疗的患者中，ACE2受体的表达也会增加。噻唑烷二酮类药物（TZDs）也能提高ACE2受体的表达。所以他们认为，由于这些药物的使用，ACE2的表达在糖尿病和其他一些疾病患者中的表达增加。他们推测，使用血管紧张素转换酶抑制剂或刺激血管紧张素转换酶的药物，如ACEI或ARBs等，以及抗炎药物治疗糖尿病和高血压，会增加罹患严重和致命性COVID-19的风险。

And then at the end of this short letter suggested that patients with cardiac diseases, hypertension or diabetes were treated with ACE2-increasing drugs, that is treated with ACE inhibitors or ARBs, are at higher risk of severe COVID-19 infection and therefore should be monitored and considered to be changed to other medications.

短文的最后，作者指出，心脏疾病、高血压或糖尿病患者应用“增加ACE2表达的”药物（如ACEI或ARBs）治疗，能够增加严重型COVID-19感染的风险。这些患者应该被密切监视，或者考虑改用其他类型的治疗药物。

Now within minutes of this being released online, this was cross social media. This was covered in the news. And I think this is an alert for us in this time of rapid dissemination of information and particularly where people are very appropriately interested in “what treatments are available for COVID?” “what are risks of COVID?”. That we might need to be very very careful leaping from early potential in the important information to actually using that information with patients.

在这个网络媒体时代，这篇文章仅上线几分钟，便被铺天盖地地各种报道。这种信息的快速传播，对我们来说是一个警告。尤其是这个时候，人们对“如何治疗COVID”和“COVID的风险是什么”这类的问题非常感兴趣。从对潜在信息的早期甄别，到对信息的实际应用，我们可能都需要慎之又慎。

So patients started calling their physicians ask them to be taken off the ACE inhibitors. Um, the problem is there was not much information here. This was a hypothesis by some very smart people putting together some interesting potential things, but by no means. Is this, uh, does this even raised to the level of an observational, a good observational trial? This was an interesting hypothesis.

随后患者开始给他们的医生打电话，要求停止使用ACE抑制剂。问题是这里并没有太多的信息。这只是一些非常聪明的人把一些有趣的潜在的东西放在一起，所做出的一个假设而已，没什么实际意义。难道他们做过什么好的观察性临床试验吗？这仅仅是一个有趣的假设。

Let me just kind of say what happened since then in terms of official statements. So the American Heart Association came out shortly after this with an analysis of the data and a very clear, unequivocal statement that “We should not be changing patients medical regiments away from ACEIs.”The data simply does not support that. We all know that as we critically looked at this data.

让我来谈谈从那时起官方声明对此的说法。AHA在这之后不久发表了一份数据分析和一个非常明确，毫不含糊的声明：我们不应该改变病人的医疗方案，不应停用ACEI类药物。目前的数据并不支持停用ACEI类药物，当我们批判性地审视这些数据时，很容易得出这一点。

相关单词学习：

comorbidity /kemɔr'bidəti/

伴发疾病，合并症

cerebrovascular disease

脑血管疾病

ACE inhibitors = angiotensin /ˌændʒioʊˈtensɪn/ converting enzyme inhibitors

血管紧张素转换酶抑制剂

angiotensin-converting enzyme 2 receptor

血管紧张素转换酶2受体

epithelial /,epɪ'θilɪəl/ cells

上皮细胞

ARBs = angiotensin receptor blockers

血管紧张素受体阻断剂

TZDs = thiazolidinediones

噻唑烷二酮类药物

anti-inflammatory

消炎药

hypothesis / haɪˈpɑːθəsɪs/

假设

获取英文文献及音频，后台回复关键词“新冠肺炎2”。

Resources:

www.thelancet.com/respiratory Vol 8 April 2020

最新《国际糖尿病》读者专属微信交流群建好了，快快加入吧！扫描左边《国际糖尿病》小助手..（微信号：guojtnb），回复“国际糖尿病读者”，ta会尽快拉您入群滴！

（来源：《国际糖尿病》编辑部）

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精“英”克糖丨高血压、糖尿病患者感染COVID-19的风险是否增加?

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