Attar Bashar M, Moore Christopher M, George Magdalena, Ion-Nedelcu Nicolae, Turbay Rafael, Zachariah Annamma, Ramadori Guiliano, Fareed Jawed, Van Thiel David H
Bashar M Attar, Rafael Turbay, Annamma Zachariah, Division of Gastroenterology and Hepatology, John H Stroger Hospital of Cook County, Chicago, IL 60612, United States.
World J Gastroenterol. 2014 Mar 7;20(9):2374-82. doi: 10.3748/wjg.v20.i9.2374.
To quantitate the simultaneous serum and ascitic fluid levels of procalcitonin and inflammatory markers in cirrhotics with and without ascites.
A total of 88 consecutive severe cirrhotic patients seen in a large city hospital liver clinic were studied and divided into two groups, those with and without ascites. Group 1 consisted of 41 cirrhotic patients with massive ascites, as demonstrated by necessity for therapeutic large-volume paracentesis. Group 2 consisted of 47 cirrhotic patients without any clinically documented ascites to include either a recent abdominal computed tomography scan or ultrasound study. Serum and ascitic fluid levels of an array of inflammatory markers, including procalcitonin, were measured and compared to each other and a normal plasma panel (NPP).
The values for inflammatory markers assayed in the serum of Groups 1 and 2, and ascitic fluid of the Group 1. The plasma levels of the inflammatory cytokines interleukin (IL)-2, IL-4, IL-6, IL-8, interferon gamma (IFNγ) and epidermal growth factor (EGF) were all significantly greater in the serum of Group 1 as compared to that of the serum obtained from the Group 2 subjects (all P < 0.05). There were significantly greater serum levels of IL-6, IL-8, IL-10, monocyte chemoattractant protein-1, tumor necrosis factor-α, vascular endothelial growth factor and EGF when comparing Group 2 to the NPP. There was no significant difference for IL-1A, IL-1B, IL-2, IL-4 and IFNγ levels between these two groups. Serum procalcitonin levels were increased in cirrhotics with ascites compared to cirrhotics without ascites, but serum levels were similar to ascites levels within the ascites group. Furthermore, many of these cytokines, but not procalcitonin, demonstrate an ascites-to-serum gradient. Serum procalcitonin does not demonstrate any significant difference segregated by liver etiology in the ascites group; but ascitic fluid procalcitonin is elevated significantly in cardiac cirrhosis/miscellaneous subgroup compared to the hepatitis C virus and alcoholic cirrhosis subgroups.
Procalcitonin in the ascitic fluid, but not in the serum, differentiates between cirrhotic subgroup reflecting the dynamic interplay of ascites, bacterial translocation and the peri-peritoneal cytokine.
定量分析伴有和不伴有腹水的肝硬化患者血清和腹水中降钙素原及炎症标志物的水平。
对一家大型城市医院肝病门诊连续收治的88例重度肝硬化患者进行研究，并将其分为两组，即有腹水组和无腹水组。第1组由41例有大量腹水的肝硬化患者组成，这通过治疗性大量腹腔穿刺放液的必要性得以证明。第2组由47例无任何临床记录腹水的肝硬化患者组成，这些患者包括近期的腹部计算机断层扫描或超声检查结果。测量一系列炎症标志物（包括降钙素原）的血清和腹水水平，并相互比较以及与正常血浆样本（NPP）进行比较。
在第1组和第2组血清以及第1组腹水中检测的炎症标志物的值。炎症细胞因子白细胞介素（IL）-2、IL-4、IL-6、IL-8、干扰素γ（IFNγ）和表皮生长因子（EGF）的血浆水平在第1组血清中均显著高于第2组受试者血清中的水平（所有P<0.05）。与NPP相比，第2组血清中IL-6、IL-8、IL-10、单核细胞趋化蛋白-1、肿瘤坏死因子-α、血管内皮生长因子和EGF的水平显著更高。这两组之间IL-1A、IL-1B、IL-2、IL-4和IFNγ水平无显著差异。与无腹水的肝硬化患者相比，有腹水的肝硬化患者血清降钙素原水平升高，但腹水组内血清水平与腹水水平相似。此外，这些细胞因子中的许多（但不是降钙素原）呈现腹水与血清梯度。腹水组中血清降钙素原在不同肝脏病因之间未显示任何显著差异；但与丙型肝炎病毒和酒精性肝硬化亚组相比，心性肝硬化/其他亚组的腹水降钙素原显著升高。
腹水中的降钙素原而非血清中的降钙素原可区分肝硬化亚组，反映腹水、细菌移位和腹膜周围细胞因子之间的动态相互作用。
