title: Serum angiotensin-converting enzyme level as a marker of fibrosis in patients with chronic hepatitis B.
abstract: BACKGROUND
  and aims: Hepatitis B virus (HBV) infection is a public health problem and affects nearly 350 million people worldwide. The present study was conducted in order to investigate the role of circulating angiotensin-converting enzyme (ACE) in the context of renin-angiotensin-aldosterone in newly diagnosed chronic hepatitis B infection. Moreover the association between liver fibrosis and serum ACE levels was also investigated.
  
  
  METHODS
  The study was performed on 50 chronic hepatitis B (CHB) patients (24 males, 26 females; median age 39.4 years, range 18-63) and 20 healthy controls. The clinical features of CHB patients including demographics, laboratory and liver biopsy findings were summarized. Serum ACE levels were measured by using commercially available kits.
  
  
  RESULTS
  Serum median ACE levels were 48.4 (14-83) U/L and 26.2 (12-48) U/L for the CHB patients and controls, respectively. Serum ACE levels were significantly higher in patients with CHB compared with the control group (p<0.001). Twenty-two patients (44%) had advanced liver fibrosis (Ishak score >2) and 28 patients (56%) had mild liver fibrosis (Ishak score ≤ 2). Mean serum levels of ACE were significantly higher among patients with advanced fibrosis as compared with those without advanced fibrosis (60.3±14.2 U/L vs. 39.0±10.5 U/L, p<0.001). Receiver operating characteristic (ROC) curve analysis suggested that the optimum ACE level cut-off point for advanced fibrosis was 52.5 U/L (sensitivity: 81.8%, specificity: 82.1%, PPV 78.3%, NPV 85.2%, accuracy 82%, AUC: 0.890).
  
  
  CONCLUSIONS
  Our study showed that elevated circulating ACE levels are commonly observed in CHB patients. This finding was more prominent in patients with advanced fibrosis in liver. When evaluating a patient along with other parameters, the inclusion of ACE levels in the evaluation of CHB patients may grant additional prognostic information.
authors.affiliation: Department of Gastroenterology, Ankara Numune Education and Research Hospital, Ankara, Turkey. purnakt@yahoo.com
authors.forename: Tugrul
authors.initials: T
authors.lastname: Purnak
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Beyazit
authors.forename: Erkin
authors.initials: E
authors.lastname: Oztas
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Yesil
authors.forename: Cumali
authors.initials: C
authors.lastname: Efe
authors.forename: Serkan
authors.initials: S
authors.lastname: Torun
authors.forename: Tugrul
authors.initials: T
authors.lastname: Celik
authors.forename: Ilyas
authors.initials: I
authors.lastname: Tenlik
authors.forename: Mevlut
authors.initials: M
authors.lastname: Kurt
authors.forename: Ersan
authors.initials: E
authors.lastname: Ozaslan
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D003710:Demography; D005260:Female; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000150:complications* / Q000201:enzymology; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications* / Q000201:enzymology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000097:blood*; D012372:ROC Curve; D012084:Renin-Angiotensin System; D055815:Young Adult
chemical_list: D015415:Biomarkers; C488034:ACE protein, human; D007703:Peptidyl-Dipeptidase A