a Department of Biological Science and Technology , National Chiao Tung University , Hsinchu , Taiwan.
b Division of Nephrology, Department of Internal Medicine , National Taiwan University Hospital Hsinchu Branch , Hsinchu , Taiwan.
Ren Fail. 2017 Nov;39(1):719-728. doi: 10.1080/0886022X.2017.1398665.
The renin-angiotensin system (RAS) has significant influences on heart and renal disease progression. Angiotensin converting enzyme (ACE) and angiotensin converting enzyme II (ACE2) are major peptidases of RAS components and play counteracting functions through angiotensin II (Ang II)/ATIR and angiotensin-(1-7) (Ang-(1-7))/Mas axis, respectively.
There were 360 uremic patients on regular hemodialysis (HD) treatment (inclusive of 119 HD patients with cardiovascular diseases (CVD) and 241 HD patients without CVD and 50 healthy subjects were enrolled in this study. Plasma ACE, ACE2, Ang II and Ang-(1-7) levels of the HD patients were determined.
We compared pre-HD levels of plasma ACE, ACE2, Ang II and Ang-(1-7) in the HD patients with and without CVD to those of the controls. The HD patients, particularly those with CVD, showed a significant increase in the levels of ACE and Ang II, whereas ACE2 and Ang-(1-7) levels were lower than those in the healthy controls. Therefore, imbalanced ACE/ACE2 was observed in the HD patients with CVD. In the course of a single HD session, the plasma ACE, ACE/ACE2 and Ang II levels in the HD patients with CVD were increased from pre-HD to post-HD. On the contrary, ACE2 levels were decreased after the HD session. These changes were not detected in the HD patients without CVD.
Pathogenically imbalanced circulating ACE/ACE2 was detected in the HD patients, particularly those with CVD. HD session could increase ACE/Ang II/AT1R axis and decrease ACE2/Ang-(1-7)/Mas axis activity in the circulation of HD patients with CVD.
肾素-血管紧张素系统（RAS）对心脏和肾脏疾病的进展有重要影响。血管紧张素转换酶（ACE）和血管紧张素转换酶 2（ACE2）是 RAS 成分的主要肽酶，通过血管紧张素 II（Ang II）/AT1R 和血管紧张素-(1-7)（Ang-(1-7))/Mas 轴分别发挥拮抗作用。
本研究纳入了 360 名接受常规血液透析（HD）治疗的尿毒症患者（包括 119 名有心血管疾病（CVD）的 HD 患者和 241 名无 CVD 的 HD 患者和 50 名健康对照者。测定了 HD 患者的血浆 ACE、ACE2、Ang II 和 Ang-(1-7)水平。
我们比较了 HD 患者和无 CVD 患者的 HD 前血浆 ACE、ACE2、Ang II 和 Ang-(1-7)水平与对照组。HD 患者，特别是 CVD 患者，ACE 和 Ang II 水平显著升高，而 ACE2 和 Ang-(1-7)水平低于健康对照组。因此，CVD 患者的 HD 中存在 ACE/ACE2 失衡。在单次 HD 治疗过程中，CVD 患者的 HD 患者血浆 ACE、ACE/ACE2 和 Ang II 水平从 HD 前到 HD 后升高。相反，HD 后 ACE2 水平降低。这些变化在无 CVD 的 HD 患者中未检测到。
在 HD 患者中检测到循环 ACE/ACE2 失衡，特别是在 CVD 患者中。HD 治疗可增加 CVD 患者循环中 ACE/Ang II/AT1R 轴的活性，并降低 ACE2/Ang-(1-7)/Mas 轴的活性。
