Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Viale Bracci 1, Siena, 53100, Italy.
Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Viale Bracci 1, Siena, 53100, Italy.
Eur J Intern Med. 2020 Aug;78:58-62. doi: 10.1016/j.ejim.2020.04.006. Epub 2020 Apr 16.
Angiotensin-converting enzyme (ACE) is an acid glycoprotein that converts angiotensin I into angiotensin II. It is produced mainly by activated alveolar macrophages and it resulted elevated in sarcoidosis patients. ACE is the only biomarker mentioned in WASOG international guidelines for the diagnosis and follow-up of sarcoidosis patients but its sensitivity and specificity are low. This study aimed to analyze serial measurements of ACE levels in sarcoidosis patients stratified according to concomitant ACE-inhibitor therapies (ACEIs).
136 serum samples from sarcoidosis patients were retrospectively enrolled in the study. Serial ACE concentrations were measured once year for each patient. Population were divided according to radiogical stages and ACEIs.
ACE concentrations resulted higher in non-ACEIs than ACEIs group (p<E-04). This result was confirmed also stratifying population according to radiological stages particularly in stage 3 (p=2E-03) or stage 2 of the disease (p<1E-04). Considering ACEIs, serum ACE levels proved to be higher in sarcoidosis patients treated with zofenopril than in those treated with perindopril (p=2E-02), enalapril (p=2E-03) or ramipril (p=2E-04). Patients treated with ACEIs showed a progressive reduction in ACE levels to five years of follow-up (p=1.3E-02) and the zofenopril group recorded the highest ACE levels (p<1E-04).
This retrospective study investigated changes in ACE levels in patients with sarcoidosis treated or not treated with ACEIs. Considering the overall low sensitivity and specificity of this biomarker, we suggest systematically investigating medical drugs prescribed for patients with sarcoidosis, in order to optimize the interpretation of ACE in clinical management.
血管紧张素转换酶（ACE）是一种酸性糖蛋白，可将血管紧张素 I 转化为血管紧张素 II。它主要由活化的肺泡巨噬细胞产生，在结节病患者中升高。ACE 是 WASOG 国际结节病患者诊断和随访指南中唯一提到的生物标志物，但它的敏感性和特异性较低。本研究旨在分析根据结节病患者同时接受的 ACE 抑制剂（ACEIs）治疗进行分层的 ACE 水平的系列测量。
本研究回顾性纳入了 136 例结节病患者的血清样本。对每位患者每年进行一次 ACE 浓度的连续测量。根据影像学分期和 ACEIs 将人群进行分组。
非 ACEIs 组的 ACE 浓度高于 ACEIs 组（p<0.001）。这一结果在根据影像学分期分层的人群中也得到了证实，特别是在疾病的第 3 期（p=2E-03）或第 2 期（p<1E-04）。考虑 ACEIs，与培哚普利相比，用佐芬普利治疗的结节病患者血清 ACE 水平更高（p=2E-02），用依那普利（p=2E-03）或雷米普利（p=2E-04）治疗的患者血清 ACE 水平更高。接受 ACEIs 治疗的患者在五年随访期间 ACE 水平呈逐渐下降趋势（p=1.3E-02），且佐芬普利组记录的 ACE 水平最高（p<1E-04）。
本回顾性研究调查了接受或不接受 ACEIs 治疗的结节病患者 ACE 水平的变化。考虑到该生物标志物的整体敏感性和特异性较低，我们建议系统地调查为结节病患者开具的药物，以优化 ACE 在临床管理中的解释。
