Schuster C, Reinhart W H, Hartmann K, Kuhn M
Medizinische Klinik, Rätische Kantons- und Regionalspital Chur.
Schweiz Med Wochenschr. 1999 Mar 6;129(9):362-9.
Angiooedema has been reported as a rare but in most cases serious adverse effect of ACE inhibitors. Recent reports have indicated that angiotensin II-receptor antagonists may also induce angiooedema. As part of the spontaneous reporting scheme in Switzerland the Swiss Drug Monitoring Centre (SANZ) has received reports on 94 cases of ACE inhibitor-induced and 4 cases of angiotension II-receptor antagonist-induced angiooedema. These 98 spontaneously reported cases were analysed in detail. 28 cases were classified as serious and in three patients intubation was even required. In 35% of cases angiooedema was induced within the first week of therapy and in 64% within the first year. In one case the angio-oedema displayed latency of 8 years. Latency of this duration shows that this adverse drug reaction (ADR) may be hard to detect. In 45 of the 98 cases the oedema persisted for more than one day (maximum 2 months), although in some instances the patients continued ACE-inhibitor therapy. In 25 cases the oedema recurred, in one instance as many as 20 times. In rare cases angiooedema may also be induced by angiotensin II-receptor antagonists, although in such instances the course of the oedema was usually milder. In two of the four reported cases angiooedema recurred after switching from an ACE inhibitor to an angiotensin II-receptor antagonists. The four reported cases from Switzerland showed a similar profile when compared with 25 internationally documented cases. Our data indicate that angiooedema is a specific ACE inhibitor ADR. A protracted latency period may be observed and recurrence of oedema is frequent. Angiotensin II-receptor antagonist-induced angiooedema may also occur in rare instances.
血管性水肿被报道为一种罕见但在大多数情况下较为严重的血管紧张素转换酶（ACE）抑制剂不良反应。最近的报告表明，血管紧张素II受体拮抗剂也可能诱发血管性水肿。作为瑞士自发报告计划的一部分，瑞士药物监测中心（SANZ）已收到94例ACE抑制剂诱发的血管性水肿报告和4例血管紧张素II受体拮抗剂诱发的血管性水肿报告。对这98例自发报告的病例进行了详细分析。28例被归类为严重病例，其中3例患者甚至需要插管。35%的病例在治疗的第一周内诱发血管性水肿，64%在第一年内诱发。有1例血管性水肿的潜伏期为8年。如此长的潜伏期表明这种药物不良反应（ADR）可能难以检测。98例中有45例水肿持续超过一天（最长2个月），尽管在某些情况下患者继续使用ACE抑制剂治疗。25例水肿复发，其中1例复发多达20次。在罕见情况下，血管紧张素II受体拮抗剂也可能诱发血管性水肿，不过在这些病例中水肿过程通常较轻。在报告的4例病例中有2例在从ACE抑制剂转换为血管紧张素II受体拮抗剂后血管性水肿复发。与25例国际文献记载的病例相比，瑞士报告的4例病例表现出相似的特征。我们的数据表明，血管性水肿是一种特定的ACE抑制剂ADR。可能会观察到较长的潜伏期，且水肿复发频繁。血管紧张素II受体拮抗剂诱发的血管性水肿也可能在罕见情况下发生。
