CAJ | 학술논문

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。
탐토을형간염간경화환자혈청신소-혈관긴장소계통（RAS）중혈관긴장소원(AGT)、혈관긴장소Ⅱ(AngⅡ)화혈관긴장소전환매(ACE)수평여간섬유화지표적관계。방법재180례연구대상중，정상인30례、경도간염30례、중도간염30례화간경화환자90례，기중간경화환자중Child-Pugh A급、B급화C급각30례。채용ELISA 법검측혈청AGT、Ang Ⅱ화ACE수평；채용화학면역법검측혈청투명질산（HA）、층점련단백（LN）、Ⅲ형전효원（PCⅢ）화Ⅳ형효원（Ⅳ-C）수평。결과간경화환자혈청HA、LN、PCⅢ、Ⅳ-C、AGT、AngⅡ화ACE수평분별위（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/L화（79.70±25.67） U/L，균현저고우정상대조조[분별위（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/L화（61.6±12.6） U/L，P<0.05]；간경화Child-Pugh A급화B급환자혈청AGT수평분별위（3.4±0.4） ng/ml화（3.3±0.6） ng/ml，균현저고우정상인（P<0.05）；간경화 Child-Pugh C급환자AngⅡ화ACE수평분별위（125.4±19.1） ng/L화（83.4±22.5） U/L,균현저고우정상인（P<0.05）；AGT、AngⅡ화ACE여간섬유화지표간균무현저성상관。결론수착간섬유화혹간경화병정적진전，환자혈장 AGT、AngⅡ화ACE수평축점승고，기생리병이성작용환유대우진일보연구。
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.