Chang C S, Yang S S, Kao C H, Yeh H Z, Chen G H
Dept of Internal Medicine, Taichung Veterans General Hospital, Taiwan, Republic of China.
Scand J Gastroenterol. 2001 Jan;36(1):92-6. doi: 10.1080/00365520150218110.
Spontaneous bacterial peritonitis (SBP) is a serious infection in cirrhotic patients with ascites. Both defects in the host defense mechanisms and the enhancement of the offensive factor (small intestinal bacterial overgrowth (SIBO)) may contribute to the development of SBP. Therefore, the aim of this study was to evaluate the role of SIBO versus various antimicrobial capacities in the pathogenesis of SBP in cirrhotic patients.
Forty-five cirrhotic patients were enrolled in this study. Bacterial overgrowth was evaluated by breath hydrogen test (BH2T). The hepatic reticuloendothelial system phagocytic index (HRESPI) was measured by intravenously injected colloid suspensions.
The Child-Pugh scores in the SBP group were higher than in the non-SBP group (10.5 +/- 2.0 versus 8.0 +/- 1.8, P < 0.01). The ascitic protein concentration was significantly lower in the SBP group than in the non-SBP group (897 +/- 425 mg/l versus 1,325 +/- 453 mg/l, P < 0.01). Furthermore, the serum C3 concentration was lower in the SBP group than in the non-SBP group (43.1 +/- 13.6 ng/dl versus 73.2 +/- 26.4 ng/dl, P < 0.01). The serum C4 concentration was also lower in the SBP group than in the non-SBP group (12.4 +/- 4.0 ng/dl versus 16.9 +/- 6.6 ng/dl, P < 0.05). The incidence of SIBO was higher in the SBP group than in the non-SBP group (68.2% versus 17.4%, P < 0.01). HRESPI values were significantly higher in the two groups of cirrhotic patients than in the normal reference. However, there were no statistical differences in HRESPI between the two groups (8.4 +/- 2.8 min in the SBP group versus 7.9 +/- 2.8 min in the non-SBP group).
The results of this study showed that the hepatic reticuloendothelial function is impaired in cirrhotic patients, but the degree of impairment does not differ between patients with and without previous history of SBP. Lower ascitic total protein, lower serum C3 and C4 concentrations, and presence of SIBO are all risk factors for SBP. Based on the results of our study, defects in the host defense mechanisms and the enhancement of the offensive factor (SIBO) may act in concert for the development of SBP.
自发性细菌性腹膜炎（SBP）是肝硬化腹水患者的一种严重感染。宿主防御机制缺陷和进攻性因素（小肠细菌过度生长（SIBO））增强均可能导致SBP的发生。因此，本研究旨在评估SIBO与各种抗菌能力在肝硬化患者SBP发病机制中的作用。
本研究纳入了45例肝硬化患者。通过呼气氢试验（BH2T）评估细菌过度生长情况。通过静脉注射胶体悬浮液测量肝网状内皮系统吞噬指数（HRESPI）。
SBP组的Child-Pugh评分高于非SBP组（10.5±2.0比8.0±1.8，P<0.01）。SBP组的腹水蛋白浓度显著低于非SBP组（897±425mg/l比1325±453mg/l，P<0.01）。此外，SBP组的血清C3浓度低于非SBP组（43.1±13.6ng/dl比73.2±26.4ng/dl，P<0.01）。SBP组的血清C4浓度也低于非SBP组（12.4±4.0ng/dl比16.9±6.6ng/dl，P<0.05）。SBP组的SIBO发生率高于非SBP组（68.2%比17.4%，P<0.01）。两组肝硬化患者的HRESPI值均显著高于正常对照组。然而，两组之间的HRESPI无统计学差异（SBP组为8.4±2.8分钟，非SBP组为7.9±2.8分钟）。
本研究结果表明，肝硬化患者肝网状内皮功能受损，但有或无SBP既往史的患者之间损伤程度无差异。腹水总蛋白降低、血清C3和C4浓度降低以及存在SIBO均是SBP危险因素。基于本研究结果，宿主防御机制缺陷和进攻性因素（SIBO）增强可能共同作用导致SBP的发生。
