急性胰腺炎患者血清ACE与ACE2的动态变化及其临床意义  

Study on the dynamic changes of the serum ACE and ACE2 in patients with acute pancreatitis

作　　者：裴茂炜 胡铭荣[2] 郑克 朱思琪 张春杰 王国良[1] 谢达飞[1] PEI Mao-wei;HU Ming-rong;ZHENG Ke;ZHU Si-qi;ZHANG Chun-jie;WANG Guo-liang;XIE Dafei(Department of General Surgery,The Zhejiang Hospital,HangZhou 310000,China;Department of General Surgery,The Affiliated Hospital of Hangzhou Normal University,HangZhou 310015,China)

机构地区：[1]浙江医院普外科,浙江杭州310000 [2]杭州师范大学附属医院普外科,浙江杭州310015

出　　处：《肝胆胰外科杂志》2019年第11期675-680,共6页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨急性胰腺炎(acute pancreatitis,AP)病程一周内血清血管紧张素转化酶(ACE)、血管紧张素转化酶2(ACE2)水平的动态变化及其临床意义。方法选取2015年9月至2018年11月杭州师范大学附属医院AP住院患者60例,按《中国急性胰腺炎诊治指南》分为轻度急性胰腺炎组(MAP,45例)和中重度急性胰腺炎组[(M)SAP,15例],进行规范化治疗,并与同期健康体检的志愿者进行比较(对照组,10例)。采用酶联免疫吸附法测定各组第1、3、7天的血清ACE、ACE2水平,并将ACE、ACE2、ACE2/ACE分别与急性生理与慢性评分II(APACHE II)作相关性分析。结果随着病情发展,MAP组和(M)SAP组患者APACHE II评分呈下降趋势,但(M)SAP组患者评分始终高于MAP组(P<0.05)。MAP组患者随APACHE II评分下降,ACE、ACE2、ACE2/ACE逐渐升高,但差异无统计学意义(P>0.05)。(M)SAP组患者随APACHE II评分下降,ACE逐渐下降(P=0.006);ACE2无明显变化(P=0.750);ACE2/ACE逐渐升高(P<0.001)。相关性分析表明,ACE与APACHE II评分呈线性正相关(r=0.543,P<0.01),ACE2/ACE与APACHE II评分呈线性负相关(r=-0.297,P<0.05)。ACE、ACE2、ACE2/ACE用于判断病情严重程度的敏感性分别为51.1%、33.3%、84.4%,特异性分别为70.0%、86.7%、63.7%。结论血清ACE、ACE2均参与了AP疾病的发生、发展,以ACE为代表的经典轴会促进胰腺炎发展;以ACE2为代表的新轴来拮抗经典轴,具有抗炎症作用。ACE2/ACE是判断病情严重程度敏感性的较高指标。Objective To explore the role of serum angiotesion-converting enzyme(ACE)and ACE2 in acute pancreatitis(AP)disease and its clinical significance.Methods Sixty patients with AP treated in the Affiliated Hospital of Hangzhou Normal University were divided into mild acute pancreatitis(MAP,n=45)group and(moderately)severe acute pancreatitis[(M)SAP,n=15]group,while healthy volunteers in the same period were selected as control group(n=10).The expression of ACE,ACE2 were examined by enzyme-linked immunosorbent assay(ELISA)on 1 st,3 rd,7 th day after onset of the disease.The levels of ACE,ACE2,ACE2/ACE among(M)SAP group,MAP group and the control group were analyzed,and their correlation with acute physiology and chronic health evaluation II(APACHE II)were calculated.Results As the disease progressed,the APACHE II scores of the MAP group and the(M)SAP group showed a downward trend,but the scores in the(M)SAP group were always higher than those in the MAP group(12.00±1.86,10.00±2.13,7.60±3.36 vs 4.56±1.78,3.27±1.59,2.04±1.90,all P<0.05).The APACHE II score decreased in the MAP group while the levels of ACE,ACE2 and ACE2/ACE increased gradually,the difference was not statistically significant(P>0.05).In the(M)SAP group,the ACE levels decreased gradually(3.02±0.76,2.51±0.71,2.17±0.74;P=0.006<0.05),ACE2 levels did not change significantly(398.68±108.09,399.10±109.13,368.74±142.55;P=0.750>0.05),ACE2/ACE gradually increased(132.13±21.24,158.83±18.66,170.14±20.52;P<0.001)as the APACHE II score decreased of the patients.Correlation analysis showed that ACE was linear correlated with APACHE II score(r=0.543,P<0.01),and ACE2/ACE was negatively correlated with APACHE II score(r=-0.297,P<0.05).The sensitivities of ACE,ACE2,and ACE2/ACE for judging the severity of the disease were 51.1%,33.3%,and 84.4%,and the specificities were 70.0%,86.7%,and 63.7%,respectively.Conclusion The serum ACE,ACE2 in AP patients are correlated with the occurrence and development of AP.The classical axis represented by ACE has the function o

关 键 词：急性胰腺炎 肾素-血管紧张素系统 血管紧张素转换酶 血管紧张素转换酶2 

分 类 号：R576[医药卫生—消化系统]