Muñoz J, García Río F, de Ramón A, Martínez I, Ortega B, García Satué J L, Pino J M, Granado S, Villamor J
Servicio de Neumología. Hospital La Paz.
Rev Clin Esp. 1993 Oct;193(5):221-4.
To evaluate the usefulness of angiotensin converting enzyme (ACE) in the differential diagnosis of active sarcoidosis in action with other interstitial and granulomatous processes.
The study involved 30 patients with a histological diagnosis of sarcoidosis, 38 subjects with anatomopathologically and/or microbiologically confirmed pleuropulmonary tuberculosis, and 12 subjects with idiopathic pulmonary fibrosis confirmed by histological studies. Following the technique developed by Rohatgi and Ryan, a radioenzymatic system was used to determine the activity of serum ACE. In patients with sarcoidosis, levels of ACE were measured in active cases as well as those in remission. Our laboratory reference values for those over 20 years of age are 39.84 +/- 9.19 mumol/min/l.
Levels of ACE were significantly higher (p < 0.001) in active sarcoidosis (67.71 +/- 17.73 mumol/min/l) than during inactivity (41.18 +/- 16.00 mumol/min/l), tuberculosis (46.99 +/- 13.65 mumol/min/l), or fibrosis (35.87 +/- 11.36 mumol/mol/l). A cut-off point of 59 mumol/min/l shows a significant association with the diagnosis of active sarcoidosis (p < 0.001) and reaches a negative predictive value of 90.90%.
The usefulness of serum ACE in the differential diagnosis of sarcoidosis should be reconsidered.
评估血管紧张素转换酶（ACE）在结节病活动期与其他间质性和肉芽肿性疾病的鉴别诊断中的作用。
该研究纳入了30例经组织学诊断为结节病的患者、38例经解剖病理学和/或微生物学确诊的胸膜肺型结核患者以及12例经组织学研究确诊的特发性肺纤维化患者。按照Rohatgi和Ryan开发的技术，使用放射酶系统测定血清ACE活性。在结节病患者中，对活动期病例以及缓解期病例均测量了ACE水平。我们实验室20岁以上人群的参考值为39.84±9.19微摩尔/分钟/升。
活动期结节病患者的ACE水平（67.71±17.7 mmol/min/L）显著高于静止期（41.18±16.00 mmol/min/L）、结核病患者（46.99±13.65 mmol/min/L）或纤维化患者（35.87±11.36 mmol/mol/L）（p<0.001）。59微摩尔/分钟/升的截断值与活动期结节病的诊断有显著相关性（p<0.001），阴性预测值达90.90%。
血清ACE在结节病鉴别诊断中的作用值得重新审视。
