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心血管药物引起的肺病

Authors
Edward D Chan, MD
Talmadge E King, Jr, MD
Section Editor
Kevin R Flaherty, MD, MS
Deputy Editor
Helen Hollingsworth, MD
Translators
曾晓宁, 副教授

引言

很多心血管药物都可能引起呼吸系统损伤，不过弥漫性肺实质疾病相当罕见(表 1A-B)。目前已经发现了几种不同的呼吸系统不良反应：上气道血管性水肿或血肿、支气管收缩、咳嗽、间质性肺炎、机化性肺炎、嗜酸性粒细胞性肺炎、药源性狼疮、急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)、弥漫性肺泡出血(diffuse alveolar hemorrhage, DAH)、胸膜炎、胸腔积液、高铁血红蛋白血症和孤立性肺部肿块。

本文将概述多种心血管药物引起的肺病。胺碘酮肺毒性的临床表现、诊断和治疗，以及间质性肺疾病的诊断方法，将单独讨论。 (参见“胺碘酮的肺毒性”和“成人间质性肺疾病的诊断方法：临床评估”和“成人间质性肺疾病诊断方法：诊断性试验”)

胺碘酮

作为抗心律失常药，胺碘酮的肺毒性不良反应广为人知。已有报道的肺病有几种，包括间质性肺炎、机化性肺炎、ARDS、DAH、肺结节、孤立性肿块，还有胸腔积液(罕见)。胺碘酮肺毒性的临床表现、发病机制、诊断和治疗将单独讨论。 (参见“胺碘酮的肺毒性”)

血管紧张素转换酶抑制剂

血管紧张素转换酶抑制剂(angiotensin converting enzyme inhibitor, ACEI)可引起咳嗽、血管性水肿，罕见情况下还可引起肺炎。

●咳嗽–所有ACEI类药物都可引发持续性干咳，且常为夜间咳嗽(见于5%-20%的患者)。咳嗽可能出现于首次用药后的几小时内，也可能出现于几周至几月后。咳嗽更常见于女性、非吸烟者和华人。咳嗽一般在停用ACEI类药物后的1-4周缓解，但一部分咳嗽患者可能需要几个月才能缓解[1]。值得警惕的是，咳嗽可能是心力衰竭的症状，因此需要进行彻底的病史询问和体格检查，以确定咳嗽是否真正与ACEI治疗相关。使用血管紧张素Ⅱ受体拮抗剂似乎并没有出现咳嗽发病率增加的现象。 (参见“血管紧张素转换酶抑制剂和血管紧张素Ⅱ受体阻滞剂的主要副作用”和“成人亚急性和慢性咳嗽的评估”)

                 

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Literature review current through: 2017-06 . | This topic last updated: 2016-04-11.
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