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中华诊断学电子杂志 ›› 2020, Vol. 08 ›› Issue (03) : 203 -207. doi: 10.3877/cma.j.issn.2095-655X.2020.03.012

所属专题: 文献

新型冠状病毒肺炎

心血管病合并新型冠状病毒肺炎患者合理应用β受体阻滞剂的思考
王元1, 毕雪斐1, 王智云2, 魏首栋1, 邓勇志3,()   
  1. 1. 030024 太原,山西省心血管病医院(研究所) 山西医科大学附属心血管病医院 山西省心血管病临床医学研究中心心内科
    2. 030024 太原,山西省心血管病医院(研究所) 山西医科大学附属心血管病医院 山西省心血管病临床医学研究中心神经内科
    3. 030024 太原,山西省心血管病医院(研究所) 山西医科大学附属心血管病医院 山西省心血管病临床医学研究中心心外科
  • 收稿日期:2020-03-12 出版日期:2020-08-26
  • 通信作者: 邓勇志

Considerations on the rational use of beta receptor blockers in patients with Corona Virus Disease 2019 and cardiovascular disease

Yuan Wang1, Xuefei Bi1, Zhiyun Wang2, Shoudong Wei1, Yongzhi Deng3,()   

  1. 1. Department of Cardiology, Shanxi Cardiovascular Hospital (Institute), the Affiliated Hospital of Shanxi Medical University and Shanxi Clinical Medical Research Center for Cardiovascular Disease, Taiyuan 030024, China
    2. Department of Neurology, Shanxi Cardiovascular Hospital (Institute), the Affiliated Hospital of Shanxi Medical University and Shanxi Clinical Medical Research Center for Cardiovascular Disease, Taiyuan 030024, China
    3. Department of Cardiovascular Surgery, Shanxi Cardiovascular Hospital (Institute), the Affiliated Hospital of Shanxi Medical University and Shanxi Clinical Medical Research Center for Cardiovascular Disease, Taiyuan 030024, China
  • Received:2020-03-12 Published:2020-08-26
  • Corresponding author: Yongzhi Deng
  • About author:
    Corresponding author: Deng Yongzhi, Email:
引用本文:

王元, 毕雪斐, 王智云, 魏首栋, 邓勇志. 心血管病合并新型冠状病毒肺炎患者合理应用β受体阻滞剂的思考[J]. 中华诊断学电子杂志, 2020, 08(03): 203-207.

Yuan Wang, Xuefei Bi, Zhiyun Wang, Shoudong Wei, Yongzhi Deng. Considerations on the rational use of beta receptor blockers in patients with Corona Virus Disease 2019 and cardiovascular disease[J]. Chinese Journal of Diagnostics(Electronic Edition), 2020, 08(03): 203-207.

严重急性呼吸综合征冠状病毒2(SARS-CoV-2)通过S蛋白与Ⅱ型肺泡上皮细胞血管紧张素转换酶2(ACE2)受体结合进入细胞,大量消耗ACE2,使肾素-血管紧张素(RAS)系统失衡,过多的血管紧张素Ⅱ(Ang Ⅱ)作用于血管紧张素受体1(AT1R),导致肺部炎症细胞浸润、肺纤维化,并增加肺毛细血管通透性,引起肺损伤。肺损伤后会诱发或加重心血管病患者原有疾病,甚至可能危及生命。β受体阻滞剂作为心血管病患者的一线用药,通过拮抗交感神经系统、抑制RAS活性,发挥减慢心率、降低心肌耗氧、降血压及减少恶性心律失常等作用,可降低心血管病患者的总死亡率。但是,β受体阻滞剂同时选择性抑制支气管平滑肌β2受体,可能诱发或加重支气管痉挛,对合并新型冠状病毒肺炎的心血管病患者,可能会进一步加重肺损伤。笔者基于β受体阻滞剂的作用机制及其在心肺血管疾病患者的获益得失,阐述心血管病合并新型冠状病毒肺炎患者如何合理使用β受体阻滞剂。

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters the host cell through spike protein (S protein) binding with angiotensin-converting enzyme 2 (ACE2) of type Ⅱ alveolar epithelial cells, consuming large amounts of ACE2, resulting in the imbalance of the renin-angiotensin system (RAS). Excessive angiotensin Ⅱ (Ang Ⅱ) acts on angiotensin receptor 1 (AT1R), promoting pulmonary inflammatory infiltration, pulmonary fibrosis, increasing pulmonary capillary permeability, and then causes pulmonary injury. Once the lung impaired, it would in return further deteriorate the cardiovascular conditions, and even deprive the life of cardiovascular patients. As one of the first-line prescribed medications for cardiovascular patients, β receptor blockers could lower the total mortality rate of cardiovascular patients by antagonizing the activation of sympathetic nervous system and deactivating the activity of RAS system, playing the critical role to slow down heart rate, reduce myocardial oxygen consumption, lower blood pressure and reduce malignant arrhythmias. However, β receptor blockers could selectively inhibit the β2 receptor on bronchial smooth muscle and induce or aggravate bronchospasm, which may further deteriorate pulmonary in cardiovascular patients with Corona Vinus Disease (COVID-19). Based on the mechanisms of β receptor blockers and their crucial roles in cardiopulmonary and vascular diseases, this paper illuminates the paradoxical scenarios of β receptor blockers application in patients with COVID-19 and cardiovascular disease during the epidemic.

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