INTRODUCTION As a homologue of the angiotensin-converting enzyme (ACE), angiotensin-converting enzyme 2 (ACE2) has been identified as the main receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) invasion. We aimed to investigate the role of serum ACE in predicting the coronavirus disease 2019 (COVID-19) disease progression and the underlying mechanisms. METHODS We retrospectively enrolled 120 patients with confirmed COVID-19 who underwent serum ACE detection on admission. The clinical characteristics and laboratory findings during hospitalization were evaluated dynamically to identify the potential risk factors for disease progression. RESULTS ACE level was demonstrated as one of the independent risk factors. Patients with ACE level ≤ 33.5 U/L showed a higher cumulative virus RNA detection rate, elevated pro-inflammatory mediators levels, declined lymphocyte count, and decreased SARS-CoV-2-specific antibodies than those with ACE level > 33.5 U/L. CONCLUSION Lower serum ACE levels in relation to delayed virus elimination, hyperinflammatory condition, and impaired host antiviral immune responses contribute to disease progression of COVID-19.

中文翻译：

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与过度炎症和抗病毒免疫反应受损相关的血清血管紧张素转化酶水平降低有助于 COVID-19 感染的进展。

引言 作为血管紧张素转换酶 (ACE) 的同系物，血管紧张素转换酶 2 (ACE2) 已被确定为严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 入侵的主要受体。我们旨在研究血清 ACE 在预测 2019 年冠状病毒病 (COVID-19) 疾病进展中的作用及其潜在机制。方法 我们回顾性招募了 120 名确诊的 COVID-19 患者，他们在入院时接受了血清 ACE 检测。动态评估住院期间的临床特征和实验室检查结果，以确定疾病进展的潜在危险因素。结果 ACE 水平被证明是独立的危险因素之一。ACE 水平≤ 33.5 U/L 的患者表现出较高的累积病毒 RNA 检出率，与 ACE 水平 > 33.5 U/L 的患者相比，促炎介质水平升高，淋巴细胞计数下降，SARS-CoV-2 特异性抗体减少。结论 与病毒清除延迟、高炎症状态和宿主抗病毒免疫反应受损相关的较低血清 ACE 水平有助于 COVID-19 的疾病进展。