Gabb G M, Ryan P, Wing L M, Hutchinson K A
Australian Medicines Handbook Pty Ltd, Adelaide, SA.
Aust N Z J Med. 1996 Dec;26(6):777-82. doi: 10.1111/j.1445-5994.1996.tb00624.x.
Angioedema is an uncommon and poorly recognised adverse reaction to angiotensin converting enzyme inhibitors (ACE-Is). The epidemiology of this association has not been described.
To examine the epidemiology of angioedema and its relation to ACE inhibitor prescribing. To examine the characteristics of angioedema occurring in patients taking ACE inhibitors.
A retrospective case control study and a case note audit were conducted of 40 patients who presented to a teaching hospital Accident and Emergency Department with angioedema on 48 occasions. One hundred and sixty control subjects presenting to the same Accident and Emergency Department but without angioedema were matched to cases by age, sex and presentation date. An ecological study comparing the numbers of angioedema admissions by age cohorts to South Australian (SA) public hospitals with the prescription volumes of ACE-Is in Australia was also undertaken.
Case control study: In patients presenting with angioedema compared with controls, the exposure odds ratio for ACE-Is was 5.1 (95% CI 2.03-12.89) and for non-steroidal anti-inflammatory drugs (NSAIDs) was 4.13 (95% CI 1.28-13.39). CASE NOTE AUDIT: 15/40 (38%) patients presenting with angioedema on 19/48 (40%) occasions were taking an ACE-I. These patients were older and less likely to have an atopic history than those not taking an ACE-I. The onset of angioedema after starting an ACE-I was delayed for greater than six months in nine patients. ACE-I therapy was continued after 53% of presentations. ECOLOGICAL STUDY: The number of admissions with angioedema to SA public hospitals increased between 1985-86 and 1994-95, predominantly in older patients, and paralleled the increasing prescription volumes of ACE-Is.
A considerable proportion of patients presenting with angioedema will be taking an ACE-I or a NSAID. The association of ACE-Is and angioedema is not well recognised, partly because the onset of angioedema may be delayed for months or years after commencement of an ACE-I. A persisting risk of angioedema is present in patients who have initially commenced an ACE-I uneventfully. The epidemiology of angioedema is now changing in parallel with the increasing use of ACE-Is.
血管性水肿是一种罕见且未得到充分认识的血管紧张素转换酶抑制剂（ACE-Is）不良反应。这种关联的流行病学情况尚未被描述。
研究血管性水肿的流行病学及其与ACE抑制剂处方的关系。研究服用ACE抑制剂患者发生血管性水肿的特征。
对40例因血管性水肿48次就诊于一家教学医院急诊科的患者进行回顾性病例对照研究和病例记录审核。选取160例就诊于同一急诊科但无血管性水肿的对照者，按年龄、性别和就诊日期与病例进行匹配。还进行了一项生态学研究，比较南澳大利亚（SA）公立医院不同年龄组血管性水肿入院人数与澳大利亚ACE-Is处方量。
病例对照研究：与对照组相比，出现血管性水肿的患者中，ACE-Is的暴露比值比为5.1（95%可信区间2.03 - 12.89），非甾体抗炎药（NSAIDs）的暴露比值比为4.13（95%可信区间1.28 - 13.39）。病例记录审核：40例出现血管性水肿的患者中，15例（38%）在48次发作中的19次（40%）正在服用ACE-I。这些患者比未服用ACE-I的患者年龄更大，患特应性病史的可能性更小。9例患者在开始服用ACE-I后血管性水肿的发作延迟超过6个月。53%的发作后仍继续使用ACE-I治疗。生态学研究：1985 - 1986年至1994 - 1995年期间，SA公立医院血管性水肿入院人数增加，主要是老年患者，且与ACE-Is处方量的增加平行。
相当一部分出现血管性水肿的患者会服用ACE-I或NSAID。ACE-Is与血管性水肿的关联未得到充分认识，部分原因是血管性水肿的发作可能在开始服用ACE-I数月或数年之后才出现。最初开始服用ACE-I时情况平稳的患者仍存在血管性水肿的持续风险。随着ACE-Is使用的增加，血管性水肿的流行病学情况正在发生变化。
