慢性HBV感染自然史患者血清血管紧张素Ⅱ水平及临床意义

Serum angiotensin Ⅱ level and its clinical significance in patients with natural history of chronic HBV infection

目的 探究慢性乙型肝炎病毒(HBV)感染自然史患者血清血管紧张素Ⅱ(AngⅡ)水平及临床意义。方法选取2018年12月—2020年12月嘉兴市第一医院收治的156例慢性HBV感染患者为研究组,同时选择同期体检60名健康者为对照组,测定并比较AngⅡ、血管紧张素Ⅱ1型受体(AT1R),血管紧张素转换酶(ACE)mRNA、AT1R mRNA水平,同时分析各指标临床意义;研究组按照自然史阶段以及纤维化程度进行分组,比较不同自然史阶段以及纤维化程度患者AngⅡ、AT1R、AT1R mRNA、ACE mRNA水平。结果 研究组患者血清AngⅡ、AT1R、AT1R mRNA、ACE mRNA水平高于对照组(P<0.05);AngⅡ、AT1R、AT1R mRNA、ACE mRNA与各指标联合用于慢性HBV感染诊断受试者工作曲线(ROC)曲线下面积(AUC)分别为0.882、0.758、0.808、0.823和0.915;不同自然史阶段患者血清AngⅡ、AT1R、AT1R mRNA水平为免疫耐受组>免疫活动组>再活动组>免疫控制组(P<0.05);随着患者肝纤维化程度增加,患者血清AngⅡ、AT1R、AT1R mRNA水平逐渐增加(P<0.05)。结论 慢性HBV感染患者血清AngⅡ水平及ACE-AngⅡ-AT1R轴激活与患者自然史阶段、肝纤维化程度关系密切,可以为患者病情评估以及治疗方案制定提供参考意见。

OBJECTIVE To explore serum angiotensin Ⅱ(Ang Ⅱ) level and its clinical significance in patients with natural history of chronic hepatitis B virus(HBV) infection. METHODS A total of 156 patients with chronic HBV infection admitted to Jiaxing First Hospital from Dec 2018 to Dec 2020 were selected as the study group. Meanwhile, 60 healthy individuals underwent physical examination during the same period were selected as the control group. The levels of Ang Ⅱ, angiotensin Ⅱ type 1 receptor(AT1 R), angiotensin-converting enzyme(ACE) mRNA and AT1 R mRNA were measured and compared, and the clinical significance of each index was analyzed. Patients in the study group were divided into groups according to the stage of natural history and fibrosis degree. The levels of AngⅡ, AT1 R, AT1 R mRNA and ACE mRNA in patients with different stages of natural history and fibrosis degrees were compared. RESULTS The levels of serum Ang Ⅱ, AT1 R, AT1 R mRNA, and ACE mRNA in study group were significantly higher than those in control group(P<0.05). The area under the receiver operator characteristic(ROC) curve(AUC) values of Ang Ⅱ, AT1 R, AT1 R mRNA, ACE mRNA and their combination for diagnosis of chronic HBV infection were 0.882, 0.758, 0.808, 0.823 and 0.915, respectively. The levels of serum Ang Ⅱ, AT1 R and AT1 R mRNA in patients with different natural history stages were significantly higher in the immune tolerance group than in the immune activity group, significantly higher than in the re-activity group, and higher than in the immune suppression group(P<0.05). With the aggravation of liver fibrosis, the levels of serum Ang Ⅱ, AT1 R and AT1 R mRNA significantly increased(P<0.05). CONCLUSION Serum Ang Ⅱ level and activation of ACE-AngⅡ-AT1 R axis are closely related to the stages of natural history and severity of liver fibrosis in patients with chronic HBV infection, which provides reference for condition assessment and development of treatment plan.