Garcia-Tsao G, Angulo P, Garcia J C, Groszmann R J, Cadelina G W
Hepatic Hemodynamic Laboratory, West Haven VA Medical Center, CT, USA.
Hepatology. 1998 Jul;28(1):17-21. doi: 10.1002/hep.510280104.
Nitric oxide (NO) is a messenger molecule involved in pathogen suppression. Cirrhosis is characterized by an increased risk for infections, including spontaneous bacterial peritonitis (SBP). The role of NO in the infections that develop in cirrhosis has not been clearly established. The aim of this study was to investigate the utility of measuring ascites NO in the diagnosis of SBP and/or in determining the predisposition of cirrhotic patients to develop this infection. Nitric oxide metabolites (nitrites + nitrates [NOx]) were measured by chemiluminescence in 105 ascites samples obtained from 87 cirrhotic patients and in 87 simultaneously obtained serum samples. Ascites NO levels were not significantly different among ascites from patients with SBP (n = 39; median, 48 micromol/L), patients with sterile ascites (n = 54; median, 42 micromol/L), and samples obtained after patients with SBP had been treated (n = 12; median, 62 micromol/L). No differences in ascites NO levels were observed between culture-positive and culture-negative peritonitis. Among 50 patients with sterile ascites on initial paracentesis, 7 patients developed peritonitis during follow-up; no differences in baseline NO levels were observed between patients who developed peritonitis (median, 46 micromol/L) and those who did not (median, 41 micromol/L). Among patients with SBP, mortality was significantly higher in those with NO levels >60 micromol/L. A very significant direct correlation was found between ascites and serum NO levels (r2 = .86). In conclusion, ascites NO levels in cirrhotic patients are not useful either to diagnose or to determine predisposition to SBP. Rather, ascites NO levels reflect serum levels, are higher in cirrhotic patients with more severe liver disease, and may be a useful prognostic marker.
一氧化氮（NO）是一种参与病原体抑制的信使分子。肝硬化的特征是感染风险增加，包括自发性细菌性腹膜炎（SBP）。NO在肝硬化患者发生的感染中的作用尚未明确。本研究的目的是探讨检测腹水NO在SBP诊断和/或确定肝硬化患者发生这种感染的易感性方面的效用。通过化学发光法测定了从87例肝硬化患者获得的105份腹水样本以及同时获得的87份血清样本中的一氧化氮代谢产物（亚硝酸盐+硝酸盐[NOx]）。SBP患者（n = 39；中位数，48 μmol/L）、无菌性腹水患者（n = 54；中位数，42 μmol/L）以及SBP患者接受治疗后获得的样本（n = 12；中位数，62 μmol/L）的腹水NO水平无显著差异。培养阳性和培养阴性腹膜炎患者的腹水NO水平未观察到差异。在初次腹腔穿刺时无菌性腹水的50例患者中，7例在随访期间发生腹膜炎；发生腹膜炎的患者（中位数，46 μmol/L）和未发生腹膜炎的患者（中位数，41 μmol/L）的基线NO水平未观察到差异。在SBP患者中，NO水平>60 μmol/L的患者死亡率显著更高。腹水和血清NO水平之间发现非常显著的直接相关性（r2 = 0.86）。总之，肝硬化患者的腹水NO水平对于诊断或确定SBP的易感性均无用。相反，腹水NO水平反映血清水平，在肝病更严重的肝硬化患者中更高，并且可能是一个有用的预后标志物。
