血管性水肿是真皮的局部肿胀,皮下组织,和/或由液体外渗到这些组织中引起的粘膜下组织。血管性水肿与某些血管活性分子有关,通常由组胺或缓激肽介导。临床上表现为面部水肿,四肢和泌尿生殖区域肿胀,和喉部的潜在参与,导致呼吸困难和吸气喘鸣,这可能会危及生命。组胺介导的血管性水肿与荨麻疹和瘙痒有关,并将显示变态反应(1型超敏反应)的典型迹象。缓激肽介导的血管性水肿通常是家族性(遗传性血管性水肿),并且通常与胃肠道症状(腹痛,恶心,呕吐,腹泻),四肢和躯干水肿,缺乏荨麻疹和瘙痒。血管紧张素转换酶抑制剂(ACEI)是一类常用的治疗高血压的药物,心力衰竭,和糖尿病肾病。ACEI与血管性水肿的风险增加有关,从轻度反应到严重和危及生命。ACEI诱导的血管性水肿是一种缓激肽介导的反应,可发生在具有遗传易感性的个体中。其他药物,如血管紧张素受体阻滞剂,非甾体抗炎药,和某些抗生素,最值得注意的是β-内酰胺类,也可引起药物性血管性水肿。本调查描述了当前的病理生理学知识,流行病学,临床表现,诱发因素,和药物诱导的血管性水肿的管理。
Angioedema is a localized swelling of the dermis, subcutaneous tissues, and/or submucosal tissues caused by fluid extravasation into these tissues. Angioedema is associated with certain vasoactive molecules and is typically mediated by histamine or
bradykinin. It manifests clinically as facial edema, swelling of the extremities and urogenital area, and potential involvement of the larynx, leading to dyspnea and inspiratory stridor, which can become life-threatening. Histamine-mediated angioedema is associated with urticaria and pruritus and will show classic signs of allergic (type 1 hypersensitivity) reactions.
Bradykinin-mediated angioedema is often familial (hereditary angioedema) and is more often associated with gastrointestinal symptoms (abdominal pain, nausea, vomiting, diarrhea), edema of the extremities and trunk, and a lack of urticaria and pruritus. Angiotensin-converting enzyme inhibitors (ACEIs) are a class of medications commonly prescribed for hypertension, heart failure, and diabetic nephropathy. ACEIs are associated with an increased risk of angioedema, which can range from a mild reaction to severe and life-threatening. ACEI-induced angioedema is a
bradykinin-mediated reaction that can occur in individuals with a genetic predisposition. Other medications, such as angiotensin receptor blockers, nonsteroidal anti-inflammatory drugs, and certain antibiotics, most notably those in the beta-lactam class, can also cause drug-induced angioedema. The present investigation describes current knowledge of the pathophysiology, epidemiology, clinical manifestations, predisposing factors, and management of drug-induced angioedema.