Dipartimento di Scienze Cliniche Luigi Sacco, Università di Milano, Ospedale L. Sacco, Milan, Italy.
Intern Emerg Med. 2010 Dec;5(6):481-6. doi: 10.1007/s11739-010-0408-3. Epub 2010 May 22.
Angioedema is a recurrent, non-pitting, non-pruritic, self-limiting swelling due to transient increase of endothelial permeability in the capillaries of the deep cutaneous and mucosal layers. Two main groups of angioedema should be distinguished based on the response to treatment: those responding to antihistamine and those that do not. Among the last ones, angioedema due to inherited (hereditary angioedema) and acquired (acquired angioedema) C1 inhibitor deficiency are the best defined, and are known to be mediated by bradykinin. The clinical picture is characterized by cutaneous, abdominal, and laryngeal symptoms that are highly disabling, and can be lethal when they affect the larynx, or if they are not promptly and adequately treated. Important advances in diagnosis and treatment of C1 inhibitor deficiency have been made in recent years, and today, we can rely on different therapeutic options to prevent symptoms or to treat those already present. Because of these advances, in patients properly diagnosed and treated, the mortality for the disease has dropped close to zero, and the quality of life for patients approaches that of normal subjects.
血管性水肿是一种反复发作的、非凹陷性、非瘙痒性、自限性肿胀,是由于真皮和黏膜深层毛细血管内皮通透性短暂增加所致。根据治疗反应,可将血管性水肿分为两大类:一类对抗组胺药有反应,另一类则无反应。在后一类中,遗传性(遗传性血管性水肿)和获得性(获得性血管性水肿)C1 抑制剂缺乏引起的血管性水肿定义最为明确,其已知由缓激肽介导。其临床表现为皮肤、腹部和喉部症状,这些症状非常严重,当它们影响喉部时,或者如果不能及时和充分地治疗,可能会致命。近年来,在 C1 抑制剂缺乏症的诊断和治疗方面取得了重要进展,如今,我们可以依靠不同的治疗方法来预防症状或治疗已经存在的症状。由于这些进展,在得到正确诊断和治疗的患者中,该疾病的死亡率已接近零,患者的生活质量接近正常水平。