Attar Bashar M, George Magdalena, Ion-Nedelcu Nicolae, Ramadori Guilliano, Thiel David H Van
Bashar M Attar, Division of Gastroenterology and Hepatology, John H Stroger Hospital of Cook County, Chicago, IL 60612, United States.
World J Hepatol. 2014 Feb 27;6(2):85-91. doi: 10.4254/wjh.v6.i2.85.
To assess differing patterns and levels of ascitic fluid cyctokine and growth factors exist between those with a high risk and low risk of spontaneous bacterial peritonitis (SBP).
A total of 57 consecutive patients with ascites requiring a large volume paracentesis were studied. Their age, gender, specific underlying disease conditions were recorded after a review of their clinical records. Each underwent a routine assessment prior to their paracentesis consisting of a complete blood count, complete metabolic profile and prothrombin time/international normalized ratio (INR) determination. The ascitic fluid was cultured and a complete cell count and albumin determination was obtained on the fluid. In addition, blood and ascitic fluid was assessed for the levels of interleukin interleukin (IL)-1A, IL-1B, IL-2, IL-4, IL-8, IL-10, monocyte chemotactic protein (MCP)-1, tumor necrosis factor (TNF)-α, interferon (IFN)-γ, vascular endothelial growth factor (VEGF) and epidermal growth factor (EGF) utilizing the Randox Biochip platforms (Boston, MA). A serum-ascites gradient, for each cytokine and growth factor was calculated. The results are reported as mean ± SEM between disease groups with statistical analysis consisting of the student t-test (two tailed) with a P value of 0.05 defining significance.
No clinically important demographic or biochemical differences between the 4 groups studied were evident. In contrast, marked difference in the cytokine and growth factors levels and pattern were evident between the 4 disease groups. Individuals with alcoholic cirrhosis had the highest levels of IL-1A, IL-1B, IL-4, IFNγ. Those with malignant disease had the highest levels of IL-2. Those with hepatitis C virus (HCV) associated cirrhosis had the highest value for IL-6, IL-8, IL-10, MCP-1 and VEGF. Those with cardiac disease had the highest level of TNF-α and EGF. The calculated serum- ascites gradients for the cardiac and malignant disease groups had a greater frequency of negative values signifying greater levels of IL-8, IL-10 and MCP-1 in ascites than did those with alcohol or HCV disease.
These data document important differences in the cytokine and growth factor levels in plasma, ascitic fluid and the calculated plasma - ascites fluid gradients in cirrhotics requiring a large volume paracentesis. These differences may be important in determining the risk for bacterial peritonitis.
评估自发性细菌性腹膜炎（SBP）高风险和低风险患者腹水中细胞因子和生长因子的不同模式及水平。
对57例连续的需要进行大量腹腔穿刺放腹水的腹水患者进行研究。在查阅他们的临床记录后，记录其年龄、性别、特定的基础疾病状况。每位患者在腹腔穿刺前都进行了常规评估，包括全血细胞计数、全代谢指标及凝血酶原时间/国际标准化比值（INR）测定。对腹水进行培养，并对腹水进行全细胞计数和白蛋白测定。此外，利用兰多克斯生物芯片平台（马萨诸塞州波士顿）评估血液和腹水中白细胞介素（IL）-1A、IL-1B、IL-2、IL-4、IL-8、IL-10、单核细胞趋化蛋白（MCP）-1、肿瘤坏死因子（TNF）-α、干扰素（IFN）-γ、血管内皮生长因子（VEGF）和表皮生长因子（EGF）的水平。计算每种细胞因子和生长因子的血清-腹水梯度。结果以疾病组之间的均值±标准误报告，统计分析采用双侧学生t检验，P值为0.05定义为有统计学意义。
所研究的4组之间在临床重要的人口统计学或生化方面无明显差异。相反，4组疾病之间细胞因子和生长因子水平及模式存在明显差异。酒精性肝硬化患者的IL-1A、IL-1B、IL-4、IFNγ水平最高。恶性疾病患者的IL-2水平最高。丙型肝炎病毒（HCV）相关性肝硬化患者的IL-6、IL-8、IL-10、MCP-1和VEGF值最高。心脏病患者的TNF-α和EGF水平最高。心脏病和恶性疾病组计算出的血清-腹水梯度负值频率更高，表明腹水中IL-8、IL-10和MCP-1水平高于酒精性或HCV疾病患者。
这些数据证明了需要进行大量腹腔穿刺放腹水的肝硬化患者血浆、腹水及计算出的血浆-腹水梯度中细胞因子和生长因子水平存在重要差异。这些差异在确定细菌性腹膜炎风险方面可能很重要。
