每日一题_2023.09.26

A 72-year-old retired man recently diagnosed with heart disease arrives at the emergency department complaining of sudden-onset abdominal pain, diarrhea, and vomiting, with mild pain and swelling throughout his face, lips, and mouth. The patient denies any pruritus. On questioning he says his primary care physician recently put him on a regimen of drugs to control his high blood pressure and cholesterol. He also mentions that he sometimes gets a rash after taking antibiotics and usually gets “hives” every spring. The physician suspects that these symptoms are related to one of the patient’s medications. The accumulation of what substance is most likely causing the patient’s symptoms?

一名最近被诊断出心脏病的72岁退休男性到急诊科时，主诉突然出现腹痛、腹泻和呕吐，面部、嘴唇和口腔出现轻度疼痛和肿胀。患者否认有任何瘙痒。在询问中，他说他的初级保健医生最近给他开了一种药物来控制他的高血压和胆固醇。他还提到，他有时会在服用抗生素后出现皮疹，通常每年春天都会出现“荨麻疹”。医生怀疑这些症状与患者的一种药物有关。什么物质的积累最有可能引起患者的症状?

(A) Bradykinin血管舒缓激肽

(B) Histamine组胺

(C) Prostacyclin环前列腺素

(D) Prostaglandin E2 前列腺素E2

(E) Serotonin5 -羟色胺

答案解析：

患者的症状是血管性水肿，这是ACE抑制剂的一种众所周知的不良反应。这些药物一般是给高血压病人开的。血管性水肿是由ACE对激肽(包括最常见的缓激肽)降解的二次活性引起。ACE的阻塞和相应的高水平缓激肽的积累是导致血管通透性增加和随后面部、嘴唇、口腔和声门下组织水肿的原因，通常不会出现瘙痒。肠水肿是患者腹泻、呕吐和腹痛等胃肠道症状的原因。既往有药物超敏反应和环境过敏史的老年患者特别容易发生ACE抑制剂引起的血管水肿。

正确答案：A