Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan.
World J Gastroenterol. 2017 Sep 28;23(36):6705-6714. doi: 10.3748/wjg.v23.i36.6705.
To evaluate the diagnostic performance of angiotensin-converting enzyme (ACE) on significant liver fibrosis in patients with chronic hepatitis B (CHB).
In total, 100 patients with CHB who underwent liver biopsy in our hospital were enrolled, and 70 patients except for 30 patients with hypertension, fatty liver or habitual alcoholic consumption were analyzed. We compared histological liver fibrosis and serum ACE levels and evaluated the predictive potential to diagnose significant liver fibrosis by comparison with several biochemical marker-based indexes such as the aspartate aminotransferase (AST)-to-platelet ratio index (APRI), the fibrosis index based on four factors (FIB-4), the Mac-2 binding protein glycosylation isomer (M2BPGi) level and the number of platelets (Plt).
Serum ACE levels showed moderately positive correlation with liver fibrotic stages ( = 0.181). Patients with significant, advanced fibrosis and cirrhosis (F2-4) had significantly higher serum ACE levels than those with early-stage fibrosis and cirrhosis (F0-1). For significant fibrosis (≥ F2), the 12.8 U/L cut-off value of ACE showed 91.7% sensitivity and 75.0% specificity. The receiver-operating characteristic (ROC) curves analysis revealed that the area under the curve (AUC) value of ACE was 0.871, which was higher than that of APRI, FIB-4, M2BPGi and Plt.
The serum ACE level could be a novel noninvasive, easy, accurate, and inexpensive marker of significant fibrosis stage in patients with CHB.
评估血管紧张素转换酶（ACE）在慢性乙型肝炎（CHB）患者中对显著肝纤维化的诊断性能。
共纳入 100 例在我院接受肝活检的 CHB 患者，除 30 例高血压、脂肪肝或习惯性饮酒患者外，对其余 70 例患者进行分析。我们比较了组织学肝纤维化和血清 ACE 水平，并通过与几个基于生化标志物的指标（如天门冬氨酸氨基转移酶（AST）与血小板比值指数（APRI）、基于四个因素的纤维化指数（FIB-4）、M2 结合蛋白糖基化异构体（M2BPGi）水平和血小板（Plt）计数）比较，评估了 ACE 诊断显著肝纤维化的预测潜力。
血清 ACE 水平与肝纤维化分期呈中度正相关（r = 0.181）。具有显著、晚期纤维化和肝硬化（F2-4）的患者血清 ACE 水平显著高于早期纤维化和肝硬化（F0-1）的患者。对于显著纤维化（≥F2），ACE 的 12.8 U/L 临界值具有 91.7%的敏感性和 75.0%的特异性。受试者工作特征（ROC）曲线分析显示，ACE 的曲线下面积（AUC）值为 0.871，高于 APRI、FIB-4、M2BPGi 和 Plt。
血清 ACE 水平可能是 CHB 患者显著纤维化分期的一种新型非侵入性、简便、准确且经济的标志物。
