Launay David
Université de Lille, faculté de médecine, 59045 Lille cedex, France; CHRU de Lille, hôpital Claude-Huriez, Centre national de référence de la sclérodermie systémique, service de médecine interne, 59037 Lille cedex, France; EA2686, 59000 Lille, France; Centre national de référence des angiœdèmes à kinine (CREAK), 38700 La Tronche, France.
Presse Med. 2015 Jan;44(1):30-6. doi: 10.1016/j.lpm.2014.06.016. Epub 2014 Dec 18.
Angioedema (AO) is a clinical syndrome defined by a local swelling of the deep dermis or subcutaneous/submucosal tissues. AO is of rapid installation, non-pruritic, always circumscribed and transitory without any sequellae. A swelling not fulfilling these characteristics is not an AO. Characterization of the bradykinic or histaminic mechanism should not be started until it is firmly established that the patient has an AO. Among differential diagnosis of AO, two clinical situations can be particularly misleading: generalized edema with flare and remission or with a subjective or objective localized predominance; permanent localized edema but with fluctuation during time. Diagnosis of AO should be questioned if the evolution is unusual or if there is a resistance to the treatment. Hereditary AO are rare diseases whereas histaminic AO are much more frequent (beware of overdiagnosis of a rare disease). Even in patients with a known and real AO, a differential diagnosis should be evoked when a new clinical manifestation is atypical or is treatment resistant.
血管性水肿（AO）是一种临床综合征，其定义为真皮深层或皮下/黏膜下组织的局部肿胀。AO起病迅速，无瘙痒，边界始终清晰且为暂时性，无任何后遗症。不符合这些特征的肿胀不是AO。在明确患者患有AO之前，不应开始对缓激肽或组胺机制进行鉴定。在AO的鉴别诊断中，有两种临床情况可能特别具有误导性：伴有皮疹发作和消退或有主观或客观局部优势的全身性水肿；永久性局部水肿但随时间波动。如果病情发展异常或对治疗有抵抗，则应质疑AO的诊断。遗传性AO是罕见疾病，而组胺性AO则更为常见（谨防对罕见疾病的过度诊断）。即使在已知患有真正AO的患者中，当出现非典型的新临床表现或对治疗有抵抗时，也应进行鉴别诊断。
