重型肝炎并发自发性细菌性腹膜炎患者血清和腹水中TNF-α、IL-6和IL-8水平的检测及意义

Detection of TNF-α, IL-6 and IL-8 in Sera and Ascites from Patients with Severe Viral Hepatitis Complicated by Spontaneous Bacterial Peritonitis and Implication

为探讨 TNF- α、IL- 6和 IL- 8在重型肝炎 (SH)并发自发性细菌性腹膜炎 (SBP)发病机理中的作用及意义。采用放射免疫法 (RIA)检测了 45例 SH并发腹水患者血清及腹水中 TNF- α、IL- 6和 IL- 8含量 ,其中腹水感染组 30例 ,腹水非感染组 15例。发现 SH并发 SBP组血清和腹水 TNF- α、 IL- 6和 IL- 8水平均显著高于腹水非感染组 (均为 P<0 .0 5 ) ,其升高水平与血清胆红素 (SB)、凝血酶原时间 (PT)呈正相关 ,与血清胆固醇 (T- ch)呈负相关 (P<0 .0 1)。感染控制后血清和腹水 TNF- α、IL- 6和 IL- 8水平明显下降 ,但仅能降至非感染组水平 (P>0 .0 5 ) ,经治疗无效死亡组血清和腹水中 TNF- α、IL- 6和 IL- 8的初始水平显著高于存活组 (均为 P<0 .0 5 )。结果表明 :TNF- α、 IL- 6和 IL- 8水平与肝细胞坏死程度和内毒素血症密切相关。检测血清和腹水中 TNF- α、IL- 6和 IL- 8含量变化对 SH并发 SBP的早期诊断。

To study the role and implication of inflammatory cytokines TNF α, IL 6 and IL 8 in the pathogenesis of severe viral hepatitis (SH) complicated by spontaneous bacterial peritonitis (SBP), the levels of TNF α, IL 6 and IL 8 in sera and ascites were detected by radioimmunoassay (RIA) from 45 patients with SH complicated by ascites, including 30 with SBP and 15 without SBP. It was found the levels of TNF α, IL 6 and IL 8 in sera and ascites in the patients with SH complicated by SBP were significantly higher than those without SBP ( P <0.05), especially the levels of IL 6 and IL 8 in ascites were higher than those in sera ( P <0.05). The elevated levels of TNF α, IL 6 and IL 8 were positively correlated with serum bilirubin (SB), prothrombin time (PT) and negatively with total cholesterol (T ch) ( P <0.01). When infections were controlled, the levels of TNF α, IL 6 and IL 8 in sera and ascites were significantly decreased but only to the levels as those in the patients without SBP ( P >0.05). The original levels of TNF α, IL 6 and IL 8 in sera and ascites of those who died were significantly higher than those of survivals ( P <0.05). The results showed TNF α, IL 6 and IL 8 played an important role in the pathogenesis of SH and were involved in the formation of ascites, and they were closely associated with the degree of hepatocyte necrosis and endotoxemia. The changes of TNF α, IL 6 and IL 8 in sera and ascites could be used as indexes to early diagnose SH complicated SBP, judge the efficacy and predict the prognosis.