Yildirim Bulent, Sari Ramazan, Isci Nuran
Inonu University, School of Medicine, Department of Internal Medicine, Turgut Ozal Medical Center, Malatya, Turkey.
J Natl Med Assoc. 2005 Feb;97(2):276-80.
Cytokines play a key role in the regulation of cells of the immune system and also have been implicated in the pathogenesis of malignant diseases.
We studied tumor necrosis factor-alpha, tumor necrosis factor receptor and C-reactive protein levels in both ascitic fluid and serum in patients with spontaneous bacterial peritonitis (SBP) (n = 22), and in the malignant (n = 38) and cirrhotic (n = 32) ascites.
C-reactive protein, tumor necrosis factor-alpha and tumor necrosis factor receptor levels in the ascitic fluid were found to be elevated in the SBP (p < 0.001) and malignant groups (p < 0.005) when compared with the sterile cirrhotic group. C-reactive protein levels in the serum were found to be elevated in the SBP group when compared with the sterile cirrhotic (p < 0.001) and malignant group (p < 0.005). Tumor necrosis factor-alpha in the serum was significantly elevated in the SBP when compared with the cirrhotic (p < 0.005) and malignant ascites (p < 0.001). Sensitivity and specificity of ascitic fluid CRP in discriminating malignant 84% and 67% and SBP from sterile ascites were 90% and 76%, respectively. Sensitivity and specificity of ascitic fluid TNF-alpha in discriminating malignant 77% and 60% and SBP from sterile ascites were 82% and 66%, respectively. Sensitivity and specificity of TNF-r p60 in discriminating malignant 74% and 70% and SBP from sterile ascites were 80% and 76%, respectively.
The sensitivity and specificity of ascitic fluid CRP, TNF-alpha and TNF-r values were found to be similar. Ascitic fluid Creactive protein to differentiate SBP and malignant ascitic from cirrhotic ascites are cheap, practical and safe tests used in the differential diagnosis of ascites.
细胞因子在免疫系统细胞的调节中起关键作用，并且也与恶性疾病的发病机制有关。
我们研究了自发性细菌性腹膜炎（SBP）患者（n = 22）以及恶性腹水（n = 38）和肝硬化腹水（n = 32）患者腹水中和血清中的肿瘤坏死因子-α、肿瘤坏死因子受体及C反应蛋白水平。
与无菌性肝硬化组相比，SBP组（p < 0.001）和恶性腹水组（p < 0.005）腹水中C反应蛋白、肿瘤坏死因子-α和肿瘤坏死因子受体水平升高。与无菌性肝硬化组（p < 0.001）和恶性腹水组（p < 0.005）相比，SBP组血清中C反应蛋白水平升高。与肝硬化腹水（p < 0.005）和恶性腹水（p < 0.001）相比，SBP组血清中肿瘤坏死因子-α显著升高。腹水CRP鉴别恶性腹水与无菌性腹水的敏感性和特异性分别为84%和67%，鉴别SBP与无菌性腹水的敏感性和特异性分别为90%和76%。腹水TNF-α鉴别恶性腹水与无菌性腹水的敏感性和特异性分别为77%和60%，鉴别SBP与无菌性腹水的敏感性和特异性分别为82%和66%。TNF-r p60鉴别恶性腹水与无菌性腹水的敏感性和特异性分别为74%和70%，鉴别SBP与无菌性腹水的敏感性和特异性分别为80%和76%。
发现腹水CRP、TNF-α和TNF-r值的敏感性和特异性相似。腹水C反应蛋白用于鉴别SBP和恶性腹水与肝硬化腹水是廉价、实用且安全的检查，可用于腹水的鉴别诊断。
