Pfaue Anja, Schuler Patrick J, Mayer Benjamin, Hoffmann Thomas K, Greve Jens, Hahn Janina
Department for Otorhinolaryngology, Head and Neck Surgery, Ulm University Hospital, Ulm, Germany.
Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
J Community Hosp Intern Med Perspect. 2019 Dec 14;9(6):453-459. doi: 10.1080/20009666.2019.1698259. eCollection 2019.
: Bradykinin-mediated angioedema (AE) induced by antihypertensive drugs primarily affect the head and neck region and may occur even after several years of uneventful treatment. Many facts about the clinical course remain unknown. Diagnosis is not easy, as the clinical appearance resembles allergic AE. No specific diagnostic markers are known and no officially approved treatment is currently available. : All patients who presented to the ORL department between 2010 and 2016 with acute AE were included. Those with a history of renin-angiotensin-aldosterone system (RAAS) blocker intake were defined as RAE and their pathophysiological characteristics and clinical course of the disease were analyzed. : A total of 84 patients (median age of 71 years) with RAE was identified. The majority (80%) was on ACE inhibition. The oral cavity was most often affected. Nearly 60% were medicated for more than 1 year before AE occurred. RAE occurred more often during the morning hours. The necessity for emergency intubation and/or tracheostomy was nine times higher in patients with acute RAE compared to patients with AE due to other reasons. : Event-free, long-term therapy with an RAAS blocker before the first development of edema does not exclude RAE. RAE is associated with an increased risk for emergency airway management. ACE: Angiotensin Converting Enzyme; ACEi AE: ACE inhibitor-induced angioedema; AE: Angioedema; ARB: Angiotensin II receptor 1 blocker; C1 INH: C1 Inhibitor; CI: Confidence Interval; CRP: C-reactive protein; DPP IV: Dipeptidyl peptidase IV; ENT: Ear, Nose and Throat; HAE: Hereditary Angioedema; ICD 10: International Statistical Classification of Diseases and Related Health Problems, 10th Edition; OR: Odds Ratio; ORL: Otorhinolaryngology; RAAS: Renin-Angiotensin-Aldosterone System; RAE: RAAS-blocker-induced angioedema.
由降压药物介导的缓激肽性血管性水肿（AE）主要影响头颈部区域，甚至在数年平稳治疗后也可能发生。关于其临床病程的许多情况仍不为人知。诊断并不容易，因为其临床表现与过敏性AE相似。目前尚无特异性诊断标志物，也没有官方批准的治疗方法。
纳入2010年至2016年间因急性AE就诊于耳鼻喉科的所有患者。有肾素-血管紧张素-醛固酮系统（RAAS）阻滞剂服用史的患者被定义为RAE，并对其疾病的病理生理特征和临床病程进行分析。
共识别出84例RAE患者（中位年龄71岁）。大多数（80%）正在接受ACE抑制剂治疗。口腔最常受累。近60%的患者在AE发生前用药超过1年。RAE更常发生在上午时段。急性RAE患者紧急插管和/或气管切开的必要性比其他原因导致AE的患者高9倍。
在首次出现水肿之前使用RAAS阻滞剂进行无事件的长期治疗并不能排除RAE。RAE与紧急气道管理风险增加相关。
血管紧张素转换酶；ACEi AE：ACE抑制剂诱导的血管性水肿；AE：血管性水肿；ARB：血管紧张素II受体1阻滞剂；C1 INH：C1抑制剂；CI：置信区间；CRP：C反应蛋白；DPP IV：二肽基肽酶IV；ENT：耳鼻喉科；HAE：遗传性血管性水肿；ICD 10：国际疾病及相关健康问题统计分类第10版；OR：比值比；ORL：耳鼻喉科；RAAS：肾素-血管紧张素-醛固酮系统；RAE：RAAS阻滞剂诱导的血管性水肿
