肝硬化患者血清血管紧张素转化酶与C反应蛋白的变化分析

Analysis on the changes of serum angiotensin-converting enzyme and C reactive protein in liver cirrhosis patients

目的探讨肝硬化患者血清血管紧张素转化酶（ACE）及C反应蛋白（CRP）的变化。方法检测275例肝硬化患者及241名健康体检者（对照组）血清ACE活性和CRP水平。肝硬化患者按肝功能Child—Pugh分级标准分为A级（96例）、B级（118例）和C级（61例）。以ACE活性〉65U／L、CRP〉10mg／L为阳性判断值，比较2组之间的阳性率。将所有研究对象分为低CRP（≤10mg／L）组（306例）和高CRP（〉10mg／L）组（210例），比较2组患病率；将275例肝硬化患者分为高ACE（／〉65U／L）组（158例）和低ACE（〈65U／L）组（117例），比较2组CRP水平。血清ACE活性与CRP水平相关性分析采用直线相关分析。结果肝硬化组A、B、C3级ACE活性及CRP水平均高于对照组（P〈0．01），且肝硬化组A、B、C3级ACE活性及CRP水平依次增高（P均〈0．01）。以ACE活性〉65u／L为阳性判断值，肝硬化组阳性率为74．5％，对照组为5．4％；以CRP〉10mg／L为阳性判断值，肝硬化组阳性率为68．7％，对照组为8．7％。高CRP组中肝硬化患病率为90．0％（189／210），低CRP组中肝硬化患病率为28．1％（86／306），前者患病率是后者的3．2倍；以低CRP组为参照组，高CRP组肝硬化患病风险的优势比（OR）=7．937[95％可信区间（CI）：6．132—10．530，P〈0．01]。高ACE组血清CRP水平[28．6（14．8～86．3）mg／L]明显高于低ACE组[15．5（4．3～42．7）mg／L]（P〈0．01）。血清ACE活性与CRP水平呈正相关（r=0．468，P〈0．01）。结论肝硬化的发生、发展伴随着ACE和CRP的变化。炎症和高ACE状态在肝硬化发生、发展中起重要作用。

Objective To investigate the changes of serum angiotensin-converting enzyme （ACE） and C reactive protein （CRP） in liver cirrhosis patients. Methods A total of 275 patients with liver cirrhosis and 241 healthy subjects （control group） were enrolled, and their serum ACE activities and CRP levels were determined. The patients with liver cirrhosis were classified into Class A （96 cases）, Class B （118 cases） and Class C （61 cases） groups according to liver function Child-Pugh classification standard. ACE activity 〉 65 U/L and CRP level 〉 10 mg/L were as positive judgment values, and the positive rates between the 2 groups were compared. All the subjects were classified into low CRP （ ≤10 rag/L） group （306 cases） and high CRP （ 〉 10 rag/L） group （210 cases）, and the prevalence rates between the 2 groups were compared. The 275 patients with liver cirrhosis were classified into high ACE （ I〉 65 U/L） group （158 cases） and low ACE （ 〈65 U/L） group （117 cases）, and the CRP levels between the 2 groups were compared. Serum ACE activities and CRP levels were analyzed by linear correlation analysis. Results The serum ACE activities and CRP levels were higher in Class A, B and C groups than in the control group （ P 〈 0.01 ） , and the serum ACE activities and CRP levels increased gradually in Class A, B and C groups（P 〈0.01 ）. For serum ACE activity 〉 65 U/L as positive judgment value, the positive rate was 74.5% in the liver cirrhosis group, and the positive rate was 5.4% in the control group. For CRP level 〉 10 mg/L as positive judgment value, the positive rate was 68.7% in the liver cirrhosis group, and the positive rate was 8.7% in the control group. The prevalence rate in the high CRP group was 90.0% （189/210） , and was 28.1% （86/306） in the low CRP group. The former prevalence rate was 3.2 times than the latter prevalence rate. When the low CRP group was as the reference group, the risk odds ratio （OR） in the high CRP group was 7. 937 [95% confidence interval （CI）： 6. 132-10. 530, P 〈0.01 ]. The CRP level in the high ACE group [28.6（14.8-86.3） mg/L] was significantly higher than that in the low ACE group 115.5（4.3-42.7） mg/L] （P 〈 0.01 ）. Serum ACE activities and CRP levels were positively correlated （ r = 0. 468, P 〈 0.01 ）. Conclusions The occurrence and development of liver cirrhosis associate with the changes of ACE and CRP. Inflammation and high ACE status play important roles in occurrence and development of liver cirrhosis.