乙型肝炎和肝硬化患者血清血管紧张素系统的变化及其与肝纤维化的关系

探讨乙型肝炎肝硬化患者血清肾素-血管紧张素系统（RAS）中血管紧张素原（AGT）、血管紧张素Ⅱ（AngⅡ）和血管紧张素转换酶（ACE）水平与肝纤维化指标的关系。方法在180例研究对象中，正常人30例、轻度肝炎30例、中度肝炎30例和肝硬化患者90例，其中肝硬化患者中Child-Pugh A级、B级和C级各30例。采用ELISA 法检测血清AGT、Ang Ⅱ和ACE水平；采用化学免疫法检测血清透明质酸（HA）、层粘连蛋白（LN）、Ⅲ型前胶原（PCⅢ）和Ⅳ型胶原（Ⅳ-C）水平。结果肝硬化患者血清HA、LN、PCⅢ、Ⅳ-C、AGT、AngⅡ和ACE水平分别为（350.7±124.9） ng/L、（307.3±139.5） ng/L、（280.3±141.3） ng/L、（256.25±110.42） ng/L、（3.45±0.66） ng/mL、（120.58±26.69） ng/L和（79.70±25.67） U/L，均显著高于正常对照组分别为（68.8±20.7） ng/L、（58.6±20.9） ng/L、（53.0±21.1） ng/L、（47.0±21.1） ng/L、（3.0±0.4） ng/ml、（104.0±13.8） ng/L和（61.6±12.6） U/L，P〈0.05]；肝硬化Child-Pugh A级和B级患者血清AGT水平分别为（3.4±0.4） ng/ml和（3.3±0.6） ng/ml，均显著高于正常人（P〈0.05）；肝硬化 Child-Pugh C级患者AngⅡ和ACE水平分别为（125.4±19.1） ng/L和（83.4±22.5） U/L,均显著高于正常人（P〈0.05）；AGT、AngⅡ和ACE与肝纤维化指标间均无显著性相关。结论随着肝纤维化或肝硬化病情的进展，患者血浆 AGT、AngⅡ和ACE水平逐渐升高，其生理病理性作用还有待于进一步研究。

Change of serum rennin-angiotensis system in patients with hepatitis B and HBV-related cirrhosis

To explore the relationship between the serum levels of proangiotensin （AGT）,an-giotensinⅡ（AngⅡ） and angiotensin converting enzyme （ACE） and index of liver fibrosis in patients with chronic hepatitis B（CHB） and HBV-related cirrhosis. Methods One-hundred and eighty patients were divided into nor-mal control group （n=30）,mild hepatitis group （n=30）,moderate hepatitis group（n=30）,and cirrhosis group （n=90）;the patients with cirrhosis were further divided into Child class A,B and C according to individual Child-Pugh score （30 in each）. The levels of AGT,Ang Ⅱ and ACE in serum sample of patients were measured by ELSIA; Serum levels of hyaluronic acid （HA）,laminin （LN）,pro-collagen type Ⅲ（PCⅢ） and collagen type IV （IV-C）were detected by chemiluminescence method. Results Serum levels of HA,LN,PCⅢ,Ⅳ-C,AGT,Ang Ⅱand ACE in patients with cirrhosis were （350.7±124.9） ng/L,（307.3±139.5） ng/L,（280.3±141.3） ng/L,（256.25± 110.42） ng/L,（3.45±0.66） ng/mL,（120.58±26.69） ng/L and （79.70±25.67） U/L,respectively,which were signifi-cantly higher than those in normal controls （68.8±20.7） ng/L,（58.6±20.9） ng/L,（53.0±21.1） ng/L,（47.0±21.1） ng/L,（3.0±0.4） ng/ml,（104.0±13.8） ng/L and （61.6±12.6） U/L,respectively,P﹤0.05];serum AGT levels in patients with Child-Pugh class A and B were （3.4±0.4） ng/ml and （3.3±0.6） ng/ml,respectively,significantly higher than those in normal controls （P﹤0.05）;serum Ang Ⅱ and ACE levels in patients with Child class C were （125.4± 19.1） ng/L and （83.4±22.5） U/L,respectively,which were significantly higher than those in the normal controls （P﹤0.05）;No linear correlation could be demonstrated between serum level of AGT,Ang Ⅱor ACE and liver fi-brosis indexes. Conclusions Serum levels of AGT, Ang Ⅱ and ACE increase significantly with the progress of liver fibrosis and cirrhosis,but not correlate with indicators of hepatic extracellular matrix metabolism.