急性胰腺炎患者血浆肾素活性、血管紧张素-Ⅱ变化的动态研究

Study on dynamic changes of plasma renin activity and angiotension- Ⅱ in patients with acute pancreatitis

目的L探讨肾素-血管紧张素-醛固酮系统（RAAS）在急性胰腺炎（AP）发生发展中的作用，为临床上对急性胰腺炎病情程度的判断和治疗提供依据。方法：对重症急性胰腺炎（SAP）、轻型急性胰腺炎（MAP）、急性胆囊炎（AC）、急性阑尾炎（AA）患者及正常对照（HC）组的血浆肾素活性（PRA）、血管紧张素-Ⅱ（AGT-Ⅱ）利用放射免疫法进行测定。结果：SAP急性期（SAP．A）PRA（4．2±1．9）ng／ml／h，AGT-Ⅱ（396．2±168．6）pg／ml；SAP恢复期（SAP．R）的PRA（1．42±0．72）ng／ml／h，AGT-Ⅱ（46．2±27．3）ng／ml，SAP．A与SAP．R比较，P〈0．05，二者比较差异有统计学意义。MAP急性期（MAEA）PRA为（1．8±0．9）ng／ml／h，AGT-Ⅱ（148．2±81．7）pg／ml；MAP恢复期（MAP．R）PRA为（1．1±0．6）ng／ml／h，AGT-Ⅱ（43．1±17．3）pg／ml，MAP．A与MAP．R比较P〈0．05，二者比较差异有统计学意义。HC的PRA为（O．66±0．43）ng／ml／h，AGT-Ⅱ（41．7±29．8）pg／ml，SAP．R、MAP．R与HC比较P〉0．05，二者比较差异无统计学意义。结论：AP恢复期的测定结果均较发病后24h内显著降低，与HC比较差异无统计学意义。且AP早期发病24h内PRA、AGT-Ⅱ显著增高，SAP较MAP升高明显。因此RAAS的恢复可以作为AP已不存在有效循环血量降低的指征。

Objective To assess the changes of plasma renin activity （PRA）, angiotensin-Ⅱ （AGT-Ⅱ） and aldosterone （ALD） in patients with acute pancreatitis （AP）. Methods Radioimmunoassay was utilized to determine the concentration of PRA and AGT-Ⅱ in patients with severe acute pancreatitis （SPA）, mild acute pancreatitis （MAP）, acute cholecystitis （AC）, acute appendicitis （AA） and in healthy controls （HC）. Results The mean concentration of plasma PRA and AGT-Ⅱ was （4.2±1. 9） ng · ml^-1· h^-1 and （396. 2±168. 6） pg · ml^-1 respectively in SAP acute phase group （A group）, 1.42±0.72 ng · ml^-1· h^ 1 and （46.2±27.3） pg · ml^-1 respectively in SAP recovery phase group （R group）. There was significant difference of PRA and AGT-Ⅱ between A group and R group （P〈0.05）. The level of PRA and AGT-Ⅱ was （1.8±0.9） ng · ml^-1 · h^-1 and （48.2 ±81.7）pg · ml^-1 respectively in MAP acute phase group, （1.14±0. 6）ng ml^-1 · h^- 1 and （43.1±17. 3） pg · ml^-1 respectively in MAP recovery phase group. There was significant difference of PRA and AGT- Ⅱ between MAP acute phase group and MAP recovery phase group （P〈0.05）. The mean concentration of PRA and AGT-Ⅱ was （0.66±0.43） ng · ml^-1· h^-1 and （41.7±29.8）pg · ml^-1 respectively in HC group. There was no significant difference of PRA and AGT- Ⅱ among SAP recovery phase group, MAP recovery phase group and HC group （P〉0.05）. Conclusion The determined result in AP recovery phase is significant lower than that within 24 h after onset. There is no statistical difference between AP recovery phase group and healthy control group. The levels of PRA and AGT- Ⅱ increase markedly in the early phase （within 24 h after onset） of AP, especially in SAP. Thus, recovery of PRA and AGT-Ⅱ may be used as a marker of available circulation volume recuperation.