Borgia M C, Celestini A, Caravella P, Catalano C
Department of Clinical Science, University La Sapienza, Rome, Italy.
Angiology. 2001 Sep;52(9):645-7. doi: 10.1177/000331970105200910.
Some clinical cases published in literature show that angiotensin-converting enzyme (ACE)-inhibitor administration may cause acute pancreatitis. In this work, the authors report a case of a patient affected by hypertension. Upon admission, the authors started antihypertensive therapy using captopril, which caused an important amylase and lipase rise within 13 days. When the ACE-inhibitor therapy was stopped, a rapid decrease of the serum enzyme was observed within 3 days. The high levels of serum amylase and lipase were linked to neutrophilia but were not associated with relevant symptomatic findings or features of pancreatopathy. The absence of the usual conditions that may cause pancreatitis, such as biliary stasis, hypercalcemia, or alcohol abuse, and the rapid decrease of serum enzyme levels after drug suspension suggested an ACE-inhibitor-induced pancreatitis. This is the first clinical report of an ACE-inhibitor-induced pancreatitis in which captopril administration was found after hospitalization. The drug suspension probably prevented other complications. This case report suggests that, when ACE-inhibitor administration is started, serum amylase and lipase should be monitored in order to prevent acute pancreatitis without waiting for clinical evidence of a pancreatopathy.
文献中发表的一些临床病例表明，使用血管紧张素转换酶（ACE）抑制剂可能会引发急性胰腺炎。在这项研究中，作者报告了一例高血压患者的病例。入院后，作者开始使用卡托普利进行抗高血压治疗，该药物在13天内导致淀粉酶和脂肪酶显著升高。当停止使用ACE抑制剂治疗后，在3天内观察到血清酶迅速下降。血清淀粉酶和脂肪酶的高水平与中性粒细胞增多有关，但与胰腺炎的相关症状表现或特征无关。由于不存在可能导致胰腺炎的常见情况，如胆汁淤积、高钙血症或酗酒，且停药后血清酶水平迅速下降，提示为ACE抑制剂所致的胰腺炎。这是首次关于住院后发现使用卡托普利导致ACE抑制剂诱发胰腺炎的临床报告。停药可能预防了其他并发症。该病例报告表明，开始使用ACE抑制剂时，应监测血清淀粉酶和脂肪酶，以预防急性胰腺炎，而无需等待胰腺炎的临床证据。
