Ordering of the Serum Angiotensin-Converting Enzyme Test in Patients Receiving Angiotensin-Converting Enzyme Inhibitor Therapy An Avoidable but Common Error
Ordering of the Serum Angiotensin-Converting Enzyme Test in Patients Receiving Angiotensin-Converting Enzyme Inhibitor Therapy An Avoidable but Common Error
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DOI：
10.1378/chest.15-1061
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发表时间：
2015-12-01
期刊：
影响因子：
9.6
通讯作者：
Genzen, Jonathan R.
中科院分区：
文献类型：
--
作者：
Krasowski, Matthew D.;Savage, Johanna;Genzen, Jonathan R.
背景：血清血管紧张素转换酶（ACE）水平可能会降低使用血管紧张素转换酶抑制剂（ACEI）药物。在这项研究中，我们确定了如何频繁en ACE水平测定接受ACEI therapy.METHODS的患者：ACE水平分析超过54个月的干预前的时间段，在一个学术医疗中心进行了回顾性分析，在ACEI治疗期间进行的测试。这些数据与在国家参考实验室测量的ACE水平的大的、去识别的数据集、ACEI抑制的体外研究以及临床样本子集中赖诺普利的液相色谱飞行时间质谱检测进行比较。在54个月的时间里，1,292名患者测量了ACE水平，其中108名患者（8.4%）在测试时接受ACEI治疗。接受ACEI治疗的患者测得的ACE水平显著降低。一般来说，临床团队没有认识到药物对ACE水平的影响。在电子健康记录中引入警告提示，在干预后17个月内，接受ACEI治疗的患者的ACE水平排序减少了60%以上。参考实验室的ACE水平的去识别数据集显示出双峰分布，峰值为非常低的ACE水平。使用液相色谱飞行时间质谱，赖诺普利的存在下，证实了一个子集的标本低ACE活性。两种不同的ACE检测的体外研究表明，在临床相关concentration.CONCLUSIONS：ACE活性的评估是often测量接受ACEI的患者，可能导致低ACE浓度和不准确的解释显着抑制活性。
BACKGROUND: Serum angiotensin-converting enzyme (ACE) levels may be decreased by use of ACE inhibitor (ACEI) medication. In this study, we determined how oft en ACE levels were measured in patients receiving ACEI therapy.METHODS: 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.RESULTS: 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 post-intervention 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.CONCLUSIONS: Assessment of ACE activity is oft en measured for patients receiving ACEIs, potentially leading to low ACE concentrations and inaccurate interpretations.