肝硬化腹水患者前炎症细胞因子的改变

Change of Cytokines Levels in Cirrhotic Patients with Ascites

目的探讨肝硬化腹水患者体内前炎症细胞因子TNF-a、IL-6的水平及改变的原因。方法采用双抗体夹心酶联免疫吸附法(ELISA)检测94例肝炎肝硬化腹水患者腹水、血液标本中TNF-a、IL-6水平,同时应用鲎试剂三肽显色基质偶氮法检测标本内毒素水平,研究以上指标的相互关系及临床意义。结果①肝炎肝硬化自发性细菌性腹膜炎(SBP)组、无菌性腹水(SA)组血浆内毒素、TNF-a、IL-6浓度均显著高于健康对照组(P值均(0.001);②SBP组腹水内毒素、TNF-a、IL-6浓度均显著高于SA组(P值均(0.001);③肝硬化腹水患者血浆内毒素与TNF-a、IL-6水平正相关(P值均<0.001)。结论①肝炎肝硬化腹水患者存在细胞因子血症。②肝炎肝硬化腹水患者TNF-a,IL-6水平升高与体内内毒素水平升高有关。

Objective To evaluate plasma and aseitic fluid levels of pro - inflammatory eyto- kines （TNF -a, IL -6 ） in cirrhotic aseitic patients. Methods The plasma and ascitic fluid levels of TNF- a, IL- 6 were assayed by a double monoelonal sandwich enzyme linked immunosorbent assay （ELISA） and the levels of endotoxin were assayed by limulus amebocyte lysate test in 94 hepatitis cirrhosis patients with aseites. Results （1）The plasma and ascitic levels of TNF - a, IL - 6 and endotoxin were significantly higher in hepatitis cirrhosis patients with spontaneous bacterial peritonitis（SBP） than those without SBP in admitting hospital （ P 〈 0. 05 ）. （2）The plasma levels of TNF - a, IL - 6 and endotoxin were higher in cirrhosis without 5BP than those in healthy control group （ P 〈 0.05 ）. （3）The plasma endotoxin level of endotoxin had significantly correlated with the level of TNF -a（ P 〈 0. 001 ） and IL- 6（ P 〈 0. 001 ）. Conclusion （1） Plasma endotoxin, TNF- a and IL- 6 levels are increased in hepatitis cirrhosis patients with ascites. （2）Endotoxin in hepatitis cirrhosis patients with ascites may stimulate some kinds of immune activated cells to produce pro - inflammatory cytokines, TNF - a and IL- 6,which may deteriorated the complications.