Bas Murat, Hoffmann Thomas K, Kojda Georg
Clinic of Otolaryngology, Heinrich-Heine-University, Düsseldorf, Germany.
Curr Opin Otolaryngol Head Neck Surg. 2006 Jun;14(3):170-5. doi: 10.1097/01.moo.0000193202.85837.7d.
Sudden occurrence of subcutaneous or submucosal swelling, the so-called angioedema, is an established and potentially life-threatening condition. Several forms of angioedema show a great variety of tissue localizations and different underlying mechanisms such as genetic mutations, allergic reactions and nonallergic reactions exist. Unfortunately, angioedema is often unrecognized and/or incorrectly treated. To change this situation, a better understanding of angioedema and possible therapeutic approaches appears necessary.
Recent investigations have shed new light on the pathomechanism of nonallergic drug-induced angioedema and new therapeutic options targeting the kallikrein-kinin system have become available for patients in clinical trials. Furthermore, extensive clinical evaluations of commonly used inhibitors of the renin-angiotensin system have provided reliable data on the incidence of angioedema induced by these drugs. Accordingly, several thousand patients worldwide experience severe fatal attacks although timely medical care would have saved their lives.
Current data suggest that the nonapetide bradykinin plays a crucial role in the pathogenesis of most forms of nonallergic angioedema, while histamine acts as the main biogenic mediator in allergic angioedema. Thus, correct diagnosis is crucial for effective treatment. Standard antiallergic drugs such as glucocorticoids and antihistamines are most probably ineffective in nonallergic angioedema forms.
皮下或黏膜下突然肿胀，即所谓的血管性水肿，是一种既定的且可能危及生命的病症。多种形式的血管性水肿表现出多种组织定位，并且存在不同的潜在机制，如基因突变、过敏反应和非过敏反应。不幸的是，血管性水肿常常未被识别和/或治疗不当。为改变这种状况，有必要更好地了解血管性水肿及可能的治疗方法。
最近的研究为非过敏性药物诱导的血管性水肿的发病机制提供了新线索，并且针对激肽释放酶-激肽系统的新治疗选择已在临床试验中可供患者使用。此外，对常用的肾素-血管紧张素系统抑制剂的广泛临床评估提供了关于这些药物诱导血管性水肿发生率的可靠数据。因此，尽管及时的医疗护理本可挽救他们的生命，但全球仍有数千名患者经历严重的致命发作。
目前的数据表明，九肽缓激肽在大多数非过敏性血管性水肿的发病机制中起关键作用，而组胺在过敏性血管性水肿中作为主要的生物活性介质。因此，正确诊断对有效治疗至关重要。标准的抗过敏药物如糖皮质激素和抗组胺药在非过敏性血管性水肿形式中很可能无效。
