Department of Pathology and the Department of Internal Medicine, University of Iowa, Iowa City, IA.
Department of Pathology and the Department of Internal Medicine, University of Iowa, Iowa City, IA.
Chest. 2015 Dec;148(6):1447-1453. doi: 10.1378/chest.15-1061.
Serum angiotensin-converting enzyme (ACE) levels may be decreased by use of ACE inhibitor (ACEI) medication. In this study, we determined how often ACE levels were measured in patients receiving ACEI therapy.
ACE levels analyzed over a 54-month preintervention time period at an academic medical center were reviewed retrospectively for tests performed during ACEI therapy. These data were compared with a large, deidentified dataset of ACE levels measured at a national reference laboratory; in vitro studies of ACEI inhibition; and liquid chromatography time-of-flight mass spectrometry detection of lisinopril in a subset of clinical specimens.
Over a 54-month period, 1,292 patients had ACE levels measured, with 108 patients (8.4%) receiving ACEI therapy at the time of testing. ACE levels measured for patients receiving ACEI therapy were substantially lower. In general, clinical teams did not recognize a medication effect on ACE levels. Introduction of a warning prompt in the electronic health record reduced the ordering of ACE levels in patients receiving ACEIs by > 60% in a 17-month postintervention time period. The deidentified dataset of ACE levels at a reference laboratory showed a bimodal distribution, with a peak of very low ACE levels. Using liquid chromatography time-of-flight mass spectrometry, the presence of lisinopril was confirmed in a subset of specimens with low ACE activity. In vitro studies of two different ACE assays showed significant inhibition of activity at clinically relevant concentrations.
Assessment of ACE activity is often measured for patients receiving ACEIs, potentially leading to low ACE concentrations and inaccurate interpretations.
血管紧张素转换酶（ACE）抑制剂（ACEI）的使用可能会降低血清 ACE 水平。在这项研究中，我们确定了接受 ACEI 治疗的患者中 ACE 水平的测量频率。
回顾性分析了在学术医疗中心进行的为期 54 个月的干预前时期内接受 ACEI 治疗的患者的 ACE 水平检测结果。将这些数据与全国参考实验室测量的大量 ACE 水平的匿名数据集、ACEI 抑制的体外研究以及临床标本中赖诺普利的液相色谱飞行时间质谱检测进行了比较。
在 54 个月期间，有 1292 名患者进行了 ACE 水平检测，其中 108 名患者（8.4%）在检测时正在接受 ACEI 治疗。接受 ACEI 治疗的患者的 ACE 水平明显降低。一般来说，临床团队并没有意识到药物对 ACE 水平的影响。电子病历中引入警告提示后，在干预后的 17 个月内，接受 ACEI 治疗的患者的 ACE 水平检测订单减少了超过 60%。参考实验室的匿名 ACE 水平数据集显示出双峰分布，ACE 水平非常低。使用液相色谱飞行时间质谱，在 ACE 活性较低的一组标本中确认了赖诺普利的存在。两种不同 ACE 测定法的体外研究显示，在临床相关浓度下，活性受到显著抑制。
评估 ACE 活性通常是为接受 ACEI 治疗的患者进行的，这可能导致 ACE 浓度降低和不准确的解释。
