Departments of aInternal Medicine I, University of Bonn, Bonn, Germany.
Eur J Gastroenterol Hepatol. 2010 Dec;22(12):1487-94. doi: 10.1097/MEG.0b013e328340c43a.
In patients with cirrhosis, bacterial DNA has been found in ascites reflecting bacterial translocation. However, the clinical relevance of this finding is ill-defined especially compared with the standard diagnostics for detection of spontaneous bacterial peritonitis (SBP). Furthermore, other DNA tests have not been sufficiently evaluated.
We prospectively included 151 patients with cirrhosis and ascites admitted to our department. The patients were evaluated for diagnosis of SBP (polymorphonuclear count > 250 cells/mm) or finding of bacterascites, defined by positive bacterial culture from ascites. To detect bacterial species of bacterial DNA fragments in ascites, broad-range polymerase chain reaction and nucleotide sequencing analysis with the LightCycler SeptiFast Kit Mgrade were performed. Routine parameters were correlated with these findings.
Eighteen of 151 patients (12%) had SBP according to the classic definition. Bacterial DNA was detected in five of these 18 patients (3%), whereas in 13 patients (9%), bacterial DNA was detected without standard SBP. Seven patients (5%) had culture-positive SBP, only in two of them bacterial DNA was detected. In multivariate analysis, C-reactive protein (P = 0.000), white blood cell count (P = 0.019), and lactic acid dehydrogenase in ascites (P = 0.000) were independently associated with SBP. In the DNA-positive ascites group, none of the assessed parameters was significantly associated with the bacterial DNA positivity.
We found no correlation between detection of bacterial DNA in ascites and SBP (polymorphonuclear count > 250/mm). In contrast to the patients with bacterial DNA in ascites, patients with SBP showed clinical signs of infection. This study provides no evidence that detection of bacterial DNA in ascites of patients with liver cirrhosis is of clinical or diagnostic relevance when using the panel of LightCycler SeptiFast Kit Mgrade.
在肝硬化患者的腹水中发现了细菌 DNA，这反映了细菌易位。然而，与自发性细菌性腹膜炎 (SBP) 的标准诊断相比，这种发现的临床相关性尚不清楚。此外，其他 DNA 检测尚未得到充分评估。
我们前瞻性纳入了我院收治的 151 例肝硬化伴腹水患者。对这些患者进行了 SBP 诊断（中性粒细胞计数>250 个/毫米）或腹水细菌阳性的评估，定义为腹水细菌培养阳性。为了检测腹水细菌 DNA 片段中的细菌种类，采用广谱聚合酶链反应和核苷酸测序分析，使用 LightCycler SeptiFast Kit Mgrade。将常规参数与这些发现相关联。
根据经典定义，151 例患者中有 18 例（12%）患有 SBP。在这 18 例患者中有 5 例（3%）检测到细菌 DNA，而在 13 例患者（9%）中则检测到了无标准 SBP 的细菌 DNA。有 7 例（5%）患者的 SBP 培养阳性，只有 2 例患者检测到细菌 DNA。多变量分析显示，C 反应蛋白（P=0.000）、白细胞计数（P=0.019）和腹水乳酸脱氢酶（P=0.000）与 SBP 独立相关。在 DNA 阳性腹水组中，评估的参数均与细菌 DNA 阳性无显著相关性。
我们未发现腹水细菌 DNA 检测与 SBP（中性粒细胞计数>250 个/毫米）之间存在相关性。与腹水细菌 DNA 阳性的患者不同，患有 SBP 的患者有感染的临床迹象。本研究表明，当使用 LightCycler SeptiFast Kit Mgrade 检测时，在肝硬化患者的腹水中检测细菌 DNA 没有临床或诊断意义。
