Loftus Patricia A, Tan Melin, Patel Gunj, Lin Juan, Helman Sam, Badhey Arvind, Du Eugenie, Smith Richard V, Fried Marvin P, Ow Thomas J
Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, U.S.A.
Laryngoscope. 2014 Nov;124(11):2502-7. doi: 10.1002/lary.24777. Epub 2014 Jun 17.
OBJECTIVES/HYPOTHESIS: To evaluate the etiology and risk factors for severe manifestation and recurrent episodes of angioedema; to evaluate efficacy of short-term and long-term management strategies for angioedema among a high-risk population.
Institutional review board-approved retrospective review of a large, urban population.
Data from 875 adult patients treated from January 2008 to December 2013 with the diagnosis of angioedema were obtained using the Clinical Looking Glass utility and review of medical records. Demographic and clinicopathologic risk factors were recorded. The major outcomes evaluated were hospital admission, need for airway intervention, and recurrent episodes of angioedema following the first presentation. Initial treatment strategy and follow-up recommendations were also recorded.
The most common cause of angioedema was angiotensin converting enzyme inhibitor (ACEi)-induced (496 [56.6%]). Significant risk factors for severe cases of angioedema included older age, Hispanic race, ACEi-induced angioedema type, American Society of Anesthesiologists class III or above, coexistent cardiopulmonary disease, and a positive smoking history. A total of 17.2% of patients experienced recurrent attacks of angioedema; of those patients, 25.9% were still taking an ACEi at subsequent presentation. Risk factors for recurrent episodes included older age, idiopathic angioedema type, and coexistent cardiopulmonary disease. Only 54.1% of patients who experienced ACEi-induced angioedema had electronic medical record documentation of these allergies.
Knowledge of risk factors for severe and recurrent episodes of angioedema and improved education for both healthcare providers and patients, specifically related to ACEi use and allergy documentation, may significantly decrease the burden and morbidity of angioedema among high risk populations.
2b.
目的/假设：评估血管性水肿严重表现及复发的病因和危险因素；评估高危人群中血管性水肿短期和长期管理策略的疗效。
经机构审查委员会批准，对一大城市人群进行回顾性研究。
使用临床视窗工具并查阅病历，获取2008年1月至2013年12月期间接受治疗的875例诊断为血管性水肿的成年患者的数据。记录人口统计学和临床病理危险因素。评估的主要结局为住院、气道干预需求以及首次就诊后血管性水肿的复发情况。还记录了初始治疗策略和随访建议。
血管性水肿最常见的病因是血管紧张素转换酶抑制剂（ACEi）诱导（496例[56.6%]）。血管性水肿严重病例的显著危险因素包括年龄较大、西班牙裔种族、ACEi诱导型血管性水肿、美国麻醉医师协会III级或以上分级、并存心肺疾病以及有吸烟史。共有17.2%的患者经历血管性水肿复发；在这些患者中，25.9%在随后就诊时仍在服用ACEi。复发的危险因素包括年龄较大、特发性血管性水肿类型以及并存心肺疾病。仅54.1%经历ACEi诱导型血管性水肿的患者在电子病历中有这些过敏记录。
了解血管性水肿严重和复发的危险因素，并改善医疗服务提供者和患者的教育，特别是与ACEi使用和过敏记录相关的教育，可能会显著降低高危人群中血管性水肿的负担和发病率。
2b。
