Druyan Amit, Shuv Noam, Lidar Merav
Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel.
Faculty of Medicine, Tel Aviv University School of Medicine, Ramat Aviv, Tel Aviv 69978, Israel.
J Clin Med. 2024 Dec 16;13(24):7657. doi: 10.3390/jcm13247657.
: ACE (angiotensin-converting enzyme) is considered a serological marker of sarcoidosis as elevated levels have been reported in 30-80% of patients. However, elevated ACE levels are also encountered in other medical conditions, and the clinical correlation between ACE levels and disease activity in sarcoidosis is disputable as well. To determine the significance of elevated ACE levels in the diagnosis and follow-up of sarcoidosis patients. : All electronic patient records in which an ACE level was recorded in a large tertiary hospital were identified using a computerized algorithm. Medical diagnoses, ACE numerical values, and clinical data were also automatically extracted. Furthermore, all records with a diagnosis of sarcoidosis were manually reviewed for ascertainment of the diagnosis and searched for additional clinical manifestations and treatment responses. : A total of 1416 records with a documented ACE level were found in the database, and 146 of the records had a diagnosis of sarcoidosis in the medical record. However, the diagnosis was excluded in 27 of these cases after a manual review of the records. Elevated ACE levels were most commonly encountered among patients with sarcoidosis, non-Hodgkin's lymphoma, cirrhosis, and interstitial lung disease. Elevated ACE levels had a positive predictive value of 12.76% and a negative predictive value of 94.6% for the diagnosis of sarcoidosis in our cohort, with a sensitivity of 63.5% and a specificity of 59.5%. Among patients with sarcoidosis, ACE levels around the time of diagnosis were higher than ACE levels in remission. However, a paired analysis did not find a statistically significant difference in ACE levels between the two timepoints. A positive correlation between lack of cardiac involvement and elevated ACE levels was found on multivariate analysis. : ACE levels are a non-specific serological marker with low specificity and sensitivity for sarcoidosis and a poor positive predictive value, but with a negative predictive value of 94.6%. Furthermore, elevated ACE levels correlated poorly with disease activity in our cohort.
血管紧张素转换酶（ACE）被视为结节病的血清学标志物，因为据报道30%-80%的患者ACE水平会升高。然而，在其他病症中也会出现ACE水平升高的情况，并且ACE水平与结节病疾病活动度之间的临床相关性也存在争议。为了确定ACE水平升高在结节病患者诊断及随访中的意义：使用计算机算法识别一家大型三级医院中记录了ACE水平的所有电子病历。同时自动提取医学诊断、ACE数值及临床数据。此外，对所有诊断为结节病的记录进行人工审核以确定诊断，并查找其他临床表现及治疗反应。在数据库中总共发现了1416条记录有ACE水平记录，其中146条记录在病历中有结节病诊断。然而，在对这些记录进行人工审核后，其中27例的诊断被排除。ACE水平升高最常见于结节病、非霍奇金淋巴瘤、肝硬化和间质性肺病患者中。在我们的队列中，ACE水平升高对结节病诊断的阳性预测值为12.76%，阴性预测值为94.6%，敏感性为63.5%，特异性为59.5%。在结节病患者中，诊断时的ACE水平高于缓解期的ACE水平。然而，配对分析未发现两个时间点之间的ACE水平存在统计学上的显著差异。多变量分析发现心脏未受累与ACE水平升高之间存在正相关。ACE水平是一种非特异性血清学标志物，对结节病的特异性和敏感性较低，阳性预测值较差，但阴性预测值为94.6%。此外，在我们的队列中，ACE水平升高与疾病活动度的相关性较差。
