Serum activity of angiotensin converting enzyme and pulmonary radiography as prognostic criteria in sarcoidosis.

To compare the prognostic value of the serum concentration of angiotensin converting enzyme (SACE) to that of pulmonary radiography, patients with mediastino-pulmonary sarcoidosis were followed over two years and then retrospectively placed in one of 2 groups, designated "cured" (CS) or "not cured" (NCS) on the basis of clinical and biologic criteria. The two groups were then compared with respect to the initial pulmonary radiologic image, and the initial SACE concentration. The initial SACE concentration (CS: 45.6 +/- 15.4 U . ml-1; NCS: 48.5 +/- 27.3 U . ml-1; means +/- SD) and the percentage of patients with elevated SACE (CS: 75%; NCS: 69%) did not differ significantly between the two groups; on the other hand, the percentage of patients with pulmonary nodules on their initial chest film was higher in the NCS group (50%) than in the CS group (21%; p less than 0.05). We conclude that pulmonary radiography is the more reliable prognostic criterion in mediastino-pulmonary sarcoidosis.

Elevation of the bronchoalveolar concentration of angiotensin I converting enzyme in sarcoidosis.

The concentration of angiotensin converting enzyme (ACE) and that of albumin (AIb) were assayed in the serum (SACE, SAlb) and in bronchoalveolar lavage fluid (LACE, LAlb). Three groups of patients were studied: 14 healthy volunteers (Group I), 45 patients with active sarcoidosis (Group II), and 7 patients with sarcoidosis in remission (Group III). The SACE in Group II (4,466 +/- 2,202 U/100 ml, mean +/- SD) was higher (p less than 0.001) than in Group I (2,470 +/- 547 U/100 ml) or in Group III (2,640 +/- 610 U/100 ml); LACE was higher in Group II (65.2 +/- 48.4 U/100 ml, p less than 0.001) than in Group I (21.1 +/- 14.7 U/100 ml), or in Group III (25.7 +/- 14.6 U/100 ml). The SAlb was found to be, respectively, 3,908 +/- 385 mg/100 ml, 3,982 +/- 965 mg/100 ml, and 3.613 +/- 222 mg/100 ml in Groups I, II, and III. The LAlb in Group II (8.2 +/- 6.2 mg/100 ml) was higher (p less than 0.01) than in Group I (2.5 +/- 1.4 mg/100 ml) or in Group III )4.1 +/- 1.0 mg/100 ml). The LACE in Group II increased with the number of alveolar lymphocytes, in nonsmokers (4 = + 0.56, df = 34, p less than 0.001) and in smokers (4 = + 0.88, df = 7, p less than 0.01). In the smokers in this group, LACE was higher with respect to the number of lymphocytes than in the nonsmokers. We conclude from this study (1) that the permeability of the alveolocapillary membrane to albumin and to ACE is increased in active pulmonary sarcoidosis, (2) that LACE increases during sarcoidosis and returns to normal when the disease is cured, and (3) that the concentration of ACE in alveolar fluid increases with tobacco use.

[Increased concentration of angiotensin I converting enzyme in the alveolar fluid of patients with sarcoidosis]. / Augmentation de la concentration de l'enzyme de conversion de l'angiotensine I dans le fluide alvéolaire de sujets sarcoidiens.

Angiotensin converting enzyme (ACE) was assayed both in serum (SACE) and in bronchoalveolar fluid lavage (LACE) in 14 healthy controls and in 45 patients with sarcoidosis with mediastinal and pulmonary involvement. Concentration of SACE was 4466 +/- 2202 U x 100 ml-1 (mean +/- SD) in sarcoidosis and 2470 +/- 547 U x 100 ml-1 (chi +/- SD) in sarcoidosis and 2470 +/- 547 U . 100 ml-1 in controls. Concentrations of LACE were 65.2 +/- 48.4 U . 100 ml-1 and 21.1 +/- 14.7 U . 100 ml-1 respectively in sarcoidosis and in controls. These results are in favor of an intraalveolar secretion of ACE in sarcoidosis. LACE could be a better criterium than SACE for the evaluation of the pulmonary activity of sarcoidosis.