文章摘要

血清ACE2在评估胆道闭锁肝纤维化及其预后中的应用价值

作者: 1吴 一波, 1吕 志宝, 1徐 伟珏, 1刘 江斌, 1郑 露露
1 上海交通大学附属儿童医院普外科,上海 200062
通讯: 吕 志宝 Email: lvzb@shchildren.com.cn
DOI: 10.3978/j.issn.2095-6959.2017.12.007

摘要

目的:研究血管紧张素转化酶2(angiotensin converting enzyme 2,ACE2)的表达在评估胆道闭锁(biliary atresia,BA)患儿肝纤维化和预后中的应用价值。方法:收集35例BA患者(BA组),14例胆总管囊肿患者(对照组),分别取肝组织及外周血,通过PCR,ELISA以及病理切片评估ACE2表达情况及其与肝纤维化和预后的相关性。结果:1)BA组患儿术前血清中ACE2基因在mRNA(0.42±0.3 vs 1.0±0.2,P=0.03)及蛋白[(3.4±0.8) μg/μL vs (4.8±0.5) μg/μL,P=0.04)]的表达水平均明显低于对照组,差异均有统计学意义。2)BA组内,术前轻度肝纤维化(Fa)组患儿血清ACE2蛋白的表达水平显著高于严重纤维化组[(3.8±0.94) μg/μL vs (2.5±0.39) μg/μL],差异有统计学意义(P<0.01)。3)BA组内,Fa组患儿术后血清ACE2蛋白表达水平高于术前[(5.09±0.96) μg/μL vs (3.8±0.94) μg/μL],差异有统计学意义(P<0.01);Fb组患儿术后和术前血清ACE2蛋白表达水平无明显差异[(2.57±1) μg/μL vs (2.52±0.39) μg/μL,P=0.87]。4)BA Kasai术后,非黄疸组(No-Jaun组)患儿血清ACE2蛋白的表达水平明显高于黄疸组(Jaun组),差异有统计学意义[(5.3±0.7) μg/μL vs (2.9±0.9) μg/μL,P=0.003]。结论:血清ACE2的表达水平与肝纤维化程度呈负相关,在评估BA患儿肝纤维化程度和预后中具有较好的临床应用价值。
关键词: 胆道闭锁;血管紧张素转化酶2;肝纤维化

Value of serum ACE2 in assessing liver fibrosis and prognosis for biliary atresia

Authors: 1WU Yibo, 1LÜ Zhibao, 1XU Weijue, 1LIU Jiangbin, 1ZHENG Lulu
1 Department of General Surgery, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai 200062, China

CorrespondingAuthor:LÜ Zhibao Email: lvzb@shchildren.com.cn

Abstract

Objective: To understand the influence factors for liver fibrosis, to explore the expression and serum concentration of angiotensin converting enzyme 2 (ACE2) and liver fibrosis in biliary atresia (BA), and to determine the relationship between serum ACE2 and prognosis in children suffering from postoperative BA. Methods: A total of 35 BA infants (the BA group) and 14 choledochocyst ones (the control group) who donated the blood and liver tissue were enrolled in this study to figure out the ACE2 by real time polymerase chain reaction and ELISA methods. The extent of fibrosis in liver samples was blindly evaluated by two experienced pathologists depending on Ishak system. Then the BA liver samples were divided into a mild liver fibrosis group (grade I to IV, Fa) and a severe liver fibrosis group (grade V to VI, Fb). Results: 1) Compared to the control group, ACE2 gene (0.42±0.3 vs 1.0±0.2, P=0.03) and ACE2 protein [(3.4±0.8) μg/μL vs (4.8±0.5) μg/μL, P=0.04] decreased significantly in BA group. 2) Compared to severe liver fibrosis group, ACE2 relative protein increased significantly [(3.8±0.94) µg/µL vs (2.5±0.39) µg/µL, P<0.01]. 3) In mild liver fibrosis, ACE2 relative protein increased significantly when compared to pre-operative [(5.09±0.96) µg/µL vs (3.80±0.94) µg/µL, P<0.01]. In severe liver fibrosis group, there were no difference between post- and pre-operative [(2.57±1) µg/µL vs (2.52±0.39) µg/µL, P=0.87]. ACE2 protein in the Jaun group was significantly higher than that in the No-Jaun group (5.3±0.7 vs 2.9±0.9, P=0.003). Conclusion: ACE2 decreases in BA group, and is associated with liver fibrosis, which may be used for evaluation of prognosis.
Keywords: biliary atresia; angiotensin-converting enzyme 2; liver fibrosis