Abbosh J, Anderson J A, Levine A B, Kupin W L
Henry Ford Health System, Division of Allergy and Clinical Immunology, Detroit, Michigan 48202, USA.
Ann Allergy Asthma Immunol. 1999 May;82(5):473-6. doi: 10.1016/S1081-1206(10)62723-8.
Angioedema in association with angiotensin converting enzyme inhibitor (ACEI) use is rare, but serious. Which patients are predisposed to the reaction and whether it involves an immune mechanism remain unclear.
To determine the frequency of ACEI angioedema in immunosuppressed cardiac and renal transplant patients.
This was a retrospective chart review of all adult cardiac (n = 156) and renal (n = 341) transplant patients followed at our hospital (years 1985 to 1995).
Of 105 cardiac and 91 renal transplant patients on a combination of immunosuppressive and ACEI therapy, 5 (4.8%) cardiac and 1 (1%) renal patients developed angioedema. This prevalence of ACEI angioedema among cardiac and renal transplant patients is 24 times and 5 times higher, respectively, than that observed in the general population (0.1% to 0.2%). Reactions often appeared after prolonged ACEI use (average 19 months; range 3 days to 6.3 years). African-Americans were significantly more likely to experience ACEI-associated angioedema (P = .034), especially among the cardiac patients where 4 of 5 reactors were African-American.
For unclear reasons, ACEI-induced angioedema (often late-onset) is more prevalent among immunosuppressed cardiac and renal transplant patients. Additionally, African-Americans are over-represented among those developing the reaction.
血管性水肿与血管紧张素转换酶抑制剂（ACEI）的使用相关，虽罕见但严重。哪些患者易发生该反应以及是否涉及免疫机制仍不清楚。
确定免疫抑制的心脏和肾移植患者中ACEI相关性血管性水肿的发生率。
这是一项对我院（1985年至1995年）随访的所有成年心脏移植患者（n = 156）和肾移植患者（n = 341）的回顾性病历审查。
在105例接受免疫抑制和ACEI联合治疗的心脏移植患者及91例肾移植患者中，5例（4.8%）心脏移植患者和1例（1%）肾移植患者发生了血管性水肿。心脏和肾移植患者中ACEI相关性血管性水肿的发生率分别比普通人群（0.1%至0.2%）高24倍和5倍。反应常在长期使用ACEI后出现（平均19个月；范围3天至6.3年）。非裔美国人发生ACEI相关性血管性水肿的可能性显著更高（P = 0.034），尤其是在心脏移植患者中，5例发生反应的患者中有4例是非裔美国人。
由于不明原因，ACEI诱导的血管性水肿（通常为迟发性）在免疫抑制的心脏和肾移植患者中更为普遍。此外，非裔美国人在发生该反应的患者中占比过高。
