西南医科大学学报2026，Vol.49Issue(5)：623-630,8.DOI:10.3969/j.issn.2096-3351.2026.05.009
血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂对ICU脓毒症相关性脑病患者的影响
Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on ICU Patients with Sepsis-Associated Encephalopathy
摘要
Abstract
Objective To investigate the association between the use of angiotensin-converting enzyme inhibitors(ACEIs)and angiotensin receptor blockers(ARBs)and all-cause mortality in patients with sepsis-associated encephalopathy(SAE)admitted to the intensive care unit(ICU).Methods This is a retrospective cohort study that identified patients with SAE from the Medical Informa-tion Mart for Intensive Care(MIMIC)database in this analysis and grouped them into the ACEI/ARB and non-ACEI/ARB groups.The baseline characteristics were balanced through propensity score matching(PSM).The association between ACEI/ARB therapy and mor-tality was assessed using Kaplan-Meier analysis and Cox proportional hazards models.Subgroup analysis was applied to investigate potential differences in the effects of drug therapy on clinical outcomes across various groups.Results Among the final participants with SAE admitted to ICU,33.6％received ACEI/ARB,while 66.4％did not.After PSM,we had 3,256 individuals in each group,most baseline characteristics were balanced.In the matched cohort,the multivariable Cox proportional hazards regression model(which further adjusted for residual confounding factors that remained unbalanced after PSM)showed that ACEI/ARB use was indepen-dently associated with a reduced risk of all-cause mortality,with a hazard ratio(HR)of 0.39(95％confidence interval(CI):0.35-0.43,P<0.001).Sensitivity analysis yielded consistent results(HR=0.37～0.38).Kaplan-Meier survival curves demonstrated that the cumulative survival rate was significantly higher in the exposed group than in the non-exposed group at all observed time points(Log-rank P<0.001).Additionally,subsequent subgroup analysis further showed that race,receiving CRRT,and having hypertension have a significant interaction with ACEI/ARB efficacy.Conclusions ACEI/ARB medications in SAE patients during hospitalization may decrease all-cause mortality.The benefit was more pronounced in patients receiving CRRT than in those not receiving CRRT.More-over,compared with patients with hypertension,the benefit in reducing mortality was greater in patients without hypertension.How-ever,more high-quality research is needed for verification.关键词
脓毒症相关性脑病/MIMIC数据库/血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂/死亡率Key words
Sepsis-associated encephalopathy(SAE)/MIMIC database/Angiotensin-converting enzyme inhibitor/Angioten-sin receptor blocker/Mortality分类
医药卫生引用本文复制引用
高伟燕,魏榛,陈伟,雷迁..血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂对ICU脓毒症相关性脑病患者的影响[J].西南医科大学学报,2026,49(5):623-630,8.基金项目
国家自然科学基金(82470290) （82470290）
