血管紧张素Ⅱ、血管紧张素（1-7）水平与HBV感染者肝硬化程度的相关性

俞冲; 顾玉玲; 李民; 顾尔莉

doi:10.3969/j.issn.1001-5256.2019.11.015

血管紧张素Ⅱ、血管紧张素（1-7）水平与HBV感染者肝硬化程度的相关性

DOI: 10.3969/j.issn.1001-5256.2019.11.015

1. 南通大学附属南通第三医院肝病科
2. 南通大学附属南通第三医院康复科
3. 南通大学附属南通第三医院科教科
4. 南通大学附属南通第三医院中西医结合肝病科

基金项目:

南通市社会发展项目(HS2014079,GJZ16104)；南通市卫计委局青项目(WQ2014037)；

详细信息

中图分类号: R575.2;R512.62
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出版历程
- 收稿日期: 2019-06-26
- 出版日期: 2019-11-20

Correlation of the levels of angiotensin Ⅱ and angiotensin (1-7) with the degree of chronic hepatitis B liver fibrosis

Department of Hepatology,Nantong Third Hospital Affiliated to Nantong University

Research funding:

摘要

摘要: 目的探讨慢性HBV感染者肝硬化患者不同阶段血浆血管紧张素Ⅱ（AngⅡ）、血管紧张素（1-7）[Ang（1-7）]的差异,及其在肝硬化发病过程中的意义。方法前瞻性选取本院2017年3月-2019年3月就诊的HBV感染者86例,分为慢性乙型肝炎（CHB）组（A组,n=25）、乙型肝炎肝硬化代偿期组（B组,n=31）及乙型肝炎肝硬化失代偿期组（C组,n=30）。应用双抗体夹心法检测患者血浆AngⅡ、Ang（1-7）水平,同时采用FibroTouch进行肝脏硬度检测（LSM）。计量资料多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验;计数资料组间比较使用χ2检验。采用Pearson相关分析血浆AngⅡ、Ang（1-7）水平与LSM值的相关性;采用Spearman等级相关分析评价血浆AngⅡ、Ang（1-7）水平与乙型肝炎肝硬化程度的相关性; logistic回归分析评价AngⅡ、Ang（1-7）水平、LSM值对乙型肝炎肝硬化的预测价值。结果随肝硬化进展,A、B、C 3组患者病程逐渐延长[（5. 2±1. 3）年vs （7. 8±1. 6）年vs （10. 1...
- 乙型肝炎,慢性 /
- 肝硬化 /
- 血管紧张素类
Abstract: Objective To investigate the differences in the plasma levels of angiotensin Ⅱ( Ang Ⅱ) and angiotensin( 1-7) [Ang( 1-7) ]in different stages among patients with chronic hepatitis B( CHB) liver fibrosis and their significance in the pathogenesis of liver fibrosis.Methods A prospective study was performed. A total of 86 patients with hepatitis B virus( HBV) infection who attended our hospital from March 2017 to March 2019 were enrolled and divided into CHB group( group A) with 25 patients,compensated hepatitis B cirrhosis group( group B) with 31 patients,and decompensated hepatitis B cirrhosis group( group C) with 30 patients. The double-antibody sandwich method was used to measure the plasma levels of Ang Ⅱ and Ang( 1-7),and FibroTouch scan was used for liver stiffness measurement( LSM). A one-way analysis of variance was used for comparison of continuous data between multiple groups,and the least significant difference t-test was used for further comparison between two groups; the chi-square test was used for comparison of categorical data between groups. A binary linear correlation analysis was used to investigate the correlation of the plasma levels of Ang Ⅱ and Ang( 1-7) with LSM; a Spearman rank correlation analysis was used to investigate the correlation of the plasma levels of Ang Ⅱ and Ang( 1-7) with the progression of CHB liver fibrosis; a logistic regression analysis was used to evaluate the value of Ang Ⅱ,Ang( 1-7),and LSM in predicting hepatitis B cirrhosis. Results With the progression of liver fibrosis from group A to group C,there was a significant increase in course of disease( 5. 2 ± 1. 3 years vs 7. 8 ± 1. 6 years vs 10. 1 ± 1. 5 years,F = 4. 266,P = 0. 002),a significant reduction in the proportion of patients receiving antiviral therapy( 76. 00% vs 64. 52% vs 53. 33%,χ2= 5. 544,P < 0. 001),significant increases in Ang II( 51. 01 ±8. 68 pg/ml vs 74. 38 ± 10. 05 pg/ml vs 102. 78 ± 13. 22 pg/ml,F = 520. 260,P < 0. 001),Ang II/Ang( 1-7) ratio( 1. 06 ± 0. 41 vs2. 32 ± 0. 23 vs 5. 82 ± 1. 24,F = 18. 860,P < 0. 001),and LSM( 6. 85 ± 1. 26 kP a vs 18. 25 ± 3. 22 kP a vs 26. 84 ± 7. 57 kP a,F = 93. 260,P <0. 001),and a significant reduction in Ang( 1-7)( 45. 93 ± 10. 24 pg/ml vs 31. 52 ± 9. 62 pg/ml vs 16. 55 ± 9. 48 pg/ml,F = 209. 860,P <0. 001). Ang II and Ang II/Ang( 1-7) ratio were positively correlated with LSM( r = 0. 623 and 0. 813,both P < 0. 01),while Ang( 1-7) was negatively correlated with LSM( r =-0. 677,P < 0. 01). Ang II,Ang II/Ang( 1-7) ratio,and LSM gradually increased with the progression of liver fibrosis( r = 0. 639,0. 886,and 0. 712,all P < 0. 01),while Ang( 1-7) was negatively correlated with the progression of liver fibrosis( r =-0. 653,P < 0. 01). Ang II/Ang( 1-7) ratio and LSM had an early warning effect for liver cirrhosis in patients with HBV infection( odds ratio = 1. 884 and 2. 015,both P < 0. 01). Conclusion In patients with HBV infection,there are gradual increases in Ang II and Ang II/Ang( 1-7) ratio and a gradual reduction in Ang( 1-7) with the aggravation of liver fibrosis. Dynamic monitoring of the plasma levels of Ang II and Ang( 1-7) can provide a reference for real-time assessment of liver fibrosis and decision-making in clinical diagnosis and treatment.
- hepatitis B,chronic /
- liver cirrhosis /
- angiotensins

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参考文献(22)

[1] LOZANO R,NAGHAVI M,FOREMAN K,et al. Global and regional mortality from 235 causes of death for 20 age groups in1990 and 2010:A systematic analysis for the Global Burden of Disease Study 2010[J]. Lancet,2012,380(9859):2095-2128.

[2] ZHAO YN,LI H. Advances in anti-hepatitis B virus targets[J]. Int J Virol,2017,24(3):197-200.(in Chinese)赵亚楠，李红．抗乙型肝炎病毒靶点研究进展[J]．国际病毒学杂志，2017,24(3):197-200.

[3] KIM G,BAIK SK. Overview and recent trends of systematic reviews and Meta-analyses in hepatology[J]. Clin Mol Hepatol,2014,20(2):137-150.

[4] YANG Y,ZHANG X. Analysis of reversal factors associated with liver fibrosis/cirrhosis in patients with chronic HBV infection after achieving virologic response[J]. J Clin Hepatol,2018,34(7):1543-1546.(in Chinese)杨艳，张新．慢性HBV感染者获得病毒学应答后肝纤维化/肝硬化逆转因素的分析[J]．临床肝胆病杂志，2018,34(7):1543-1546.

[5] GRANZOW M,SCHIERWAGEN R,KLEIN S,et al. Angiotensin-II type 1 receptor-mediated Janus kinase 2 activation induces liver fibrosis[J]. Hepatology,2014,60(1):334-348.

[6] Chinese Society of Hepatology and Chinese Society of Infectious Diseases,Chinese Medical Association. Guideline of prevention and treatment for chronic hepatitis B(2015 Update)[J]. J Clin Hepatol,2015,31(12):1941-1960.(in Chinese)中华医学会肝病学分会，中华医学会感染病学分会．慢性乙型肝炎防治指南(2015年更新版)[J]．临床肝胆病杂志，2015,31(12):1941-1960.

[7] HUANG Y,DENG X,LIANG J. Modulation of hepatic stellate cells and reversibility of hepatic fibrosis[J]. Exp Cell Res,2017,352(2):420-426.

[8] SIMOES-E-SILVA AC,MIRANDA AS,ROCHA NP,et al.Renin angiotensin system in liver diseases:Friend or foe?[J]. World J Gastroenterol,2017,23(19):3396-3406.

[9] ENGELI S,NEGREL R,SHARMA AM. Physiology and pathophysiology of the adipose tissue renin-angiotensin system[J]. Hypertension,2000,35(6):1270-1277.

[10] RODRIGUES PRESTES TR,ROCHA NP,MIRANDA AS. et al.The anti-inflammatory potential of ACE2/angiotensin-(1-7)/mas receptor axis:Evidence frombasic and clinical research[J]. Curr Drug Targets,2017,18(11):1301-1313.

[11] de OLIVEIRA da SILVA B,ALBERICI LC,RAMOS LF,et al.Altered global microRNA expression in hepatic stellate cells LX-2 by angiotensin-(1-7)and mi RNA-1914-5p identification as regulator of pro-fibrogenic elements and lipid metabolism[J]. Int J Biochem Cell Biol,2018,98:137-155.

[12] LI YF,HUO LJ,ZHANG J,et al. Effects of Ang(1-7)on Mas receptor,TGF-β1/Smad3,CTGF induced by AngⅡin hepatic stellate cell[J/CD]. Chin J Digest Med Imageol(Electronic Edition),2016,6(3):124-129.(in Chinese)李亚芳，霍丽娟，张婕．等．Ang(1-7)对AngⅡ诱导的肝星状细胞Mas受体、TGF-β1/Samd3、CTGF的影响[J/CD]．中华消化病与影像杂志(电子版)，2016,6(3):124-129.

[13] HU QD,HU ZZ,CHEN QF,et al. BML-111 equilibrated ACE-AngII-AT1R and ACE2-Ang-(1-7)-Mas axis to protect hepatic fibrosis in rats[J]. Prostaglandins Other Lipid Mediat,2017,131:75-82.

[14] MENG F,ZHENG Y,ZHANG Q,et al. Noninvasive evaluation of liver fibrosis using real-time tissue elastography and transient elastography(FibroScan)[J]. J Ultrasound Med,2015,34(3):403-410.

[15] HASHEMI SA,ALAVIAN SM,GHOLAMI-FESHARAKI M,et al. Assessment of transient elastography(FibroScan)for diagnosis of fibrosis in non-alcoholic fatty liver disease:A systematic review and Meta-analysis[J]. Caspian J Intern Med,2016,7(4):242-252.

[16] LEI JW,TAN BB,LI WB,et al. Value of transient elastography measured with Fibro Touch in the diagnosis of liver fibrosis in chronic hepatitis patients with hepatocellular carcinoma[J].Chin J Med Offic,2017,45(9):930-933.(in Chinese)雷洁雯，谭碧波，李万斌，等．Fibro Touch瞬时弹性成像诊断慢性乙型肝炎合并肝癌患者肝纤维化程度应用研究[J]．临床军医杂志，2017,45(9):930-933.

[17] WU N,ZHANG MY,WU RH. et al. Diagnostic values of FibroScan and FibroTouch for liver fibrosis:A comparative analysis[J]. J Clin Hepatol,2014,30(7):624-627.(in Chinese)吴娜，张明媛，吴瑞红，等．FibroTouch与FibroScan对肝纤维化程度诊断价值的比较分析[J]．临床肝胆病杂志，2014,30(7):624-627.

[18] QI M. Study and analysis of correlation of liver hardness tester FibroTouch and FibroScan with pathological stage of liver[J].China Med Pharm,2016,6(21):218-220.(in Chinese)亓民．研究分析肝脏硬度测定仪FibroTouch与FibroScan与肝脏病理分期的相关性[J]．中国医药科学，2016,6(21):218-220.

[19] SHIM KY,EOM YW,KIM MY,et al. Role of the renin-angiotensin system in hepatic fibrosis and portal hypertension Korean[J]. J Intern Med,2018,33(3):453-461.

[20] LI XY,PENG Y,BU XW,et al. Balancing effect of biejiajian oral liquid on ACE-Ang II-AT1R axis and ACE2-Ang-(1-7)-Mas axis in rats with CCl4-induced hepatic fibrosis[J].Chin J Integr Med,2018,24(11):853-859.

[21] YUAN Y,ZHU H. Correlation of serum hyaluronidase with AngⅡin hepatitis B patients[J]. Chongqing Med,2013,42(26):3120-3121.(in Chinese)袁勇，朱洪．乙型肝炎患者血清HA与AngⅡ的相关性研究[J]．重庆医学，2013,42(26):3120-3121.

[22] YANG ZH,SHEN FJ,HUANG HF. Change of AngⅡ，Ang(1-7)and AngⅡ/Ang(1-7)ratio in patients with hepatitis B and HBV-related cirrhosis[J/CD]. Chin J Clinicians(Electronic Edition),2016,10(8):1062-1065.(in Chinese)杨志花，申凤俊，黄会芳．慢性乙型肝炎和肝硬化患者AngⅡ、Ang(1-7)及AngⅡ/Ang(1-7)比值的变化[J/CD]．中华临床医师杂志(电子版)，2016,10(8):1062-1065.

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