肝硬化自发性细菌性腹膜炎患者前炎症细胞因子的改变

Changes of pro-inflammatory cytokines in hepatic sclerosis complicated with spontaneous bacterial peritonitis patients

目的探讨肝硬化自发性细菌性腹膜炎(SBP)患者和肝硬化伴无菌性腹水(SA)患者体内前炎症细胞因子肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)的水平及改变的临床意义。方法采用双抗体夹心酶联免疫吸附法(ELISA)检测188例肝炎肝硬化腹水患者[其中肝硬化伴有自发性细菌性腹膜炎(SBP组)78例,肝硬化伴有无菌性腹水(SA组)110例]腹水、血液标本中TNF-α、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(LPS)水平。同期20例健康体检者作为健康对照组,并对三组LPS、TNF-α、IL-6水平进行比较。结果 SBP组、SA组血浆LPS、TNF-α、IL-6浓度均显著高于健康对照组(P<0.001);SBP组腹水LPS、TNF-α、IL-6浓度均显著高于SA组(P<0.001);肝硬化腹水患者血浆内毒素与TNF-α、IL-6水平呈正相关(P<0.05)。结论肝炎肝硬化腹水患者存在内毒素血症,肝炎肝硬化腹水患者TNF-α、IL-6水平升高与体内内毒素水平升高有关。

Objective To investigate clinical significance of level changes of pro-inflammatory cytokines tumor necrosis factor-α （TNF-α） and interleukin-6 （IL-6） in hepatic sclerosis complicated with spontaneous bacterial peritonitis （SBP） patients and hepatic sclerosis complicated with sterile ascites （SA） patients. Methods Double antibody enzyme-linked immune sorbent assays （ELISA） was applied to detect levels of ascites, TNF- α and IL-6 in blood samples of 188 hepatic sclerosis patients. Among them there were 78 cases of hepatic sclerosis complicated with spontaneous bacterial peritonitis （SBP group） and 110 cases of hepatic sclerosis complicated with sterile ascites （SA group）. Tachypleus amebocyte lysate tripeptide chromogenic substrate azo method was applied to detect endotoxin （LPS） levels. There were another healthy people at the same period as health control group. Comparisons were made on LPS, TNF- α, and IL-6 levels in the three groups. Results SBP group and SA group both had obviously higher levels of plasma LPS, TNF- α and IL-6 than the health control group （P〈0.001）. SBP group had much higher levels of ascites LPS, TNF- α and IL-6 than SA group （P〈0.001）. Plasma LPS in hepatic sclerosis ascites patients had positive correlation with TNF-α and IL-6 （P〈0.05）. Conclusion Endotoxemia exists in hepatitis cirrhotic ascites patients. Increased TNF- α and IL-6 are related with increased endotoxin in hepatitis cirrhotic ascites patients.