肝硬化合并自发性细菌性腹膜炎患者腹水降钙素原与细胞因子和肠黏膜屏障功能的相关性研究

Study on the relationship between procalcitonin in ascites,cytokines and intestinal mucosal barrier function in patients with cirrhosis and spontaneous peritonitis

目的探讨肝硬化合并自发性细菌性腹膜炎(SBP)患者腹水中降钙素原(PCT)的水平,及其与细胞因子水平、肠黏膜屏障功能的相关性。方法回顾性收集2016年7月至2018年5月首都医科大学附属北京天坛医院收治的98例肝硬化腹水患者资料,其中自发性细菌性腹膜炎患者59例,非感染患者39例。比较两组患者腹水标本中PCT、炎症因子[白细胞介素-1β(IL-1β)、白细胞介素-2(IL-2)、白细胞介素-17(IL-17)、白细胞介素-22(IL-22)]、乳铁蛋白,及外周血中肠黏膜屏障功能相关指标[D-乳酸、二胺氧化酶(DAO)、内毒素]水平的差异,采用Pearson检验评估腹水PCT水平与炎症因子及肠黏膜屏障功能指标的相关性。结果 SBP患者腹水标本中PCT(1. 02±0. 13 ng/ml vs. 0. 37±0. 07 ng/ml)、炎症因子(IL-1β、IL-2、IL-17、IL-22)及乳铁蛋白的水平高于非感染组患者(155. 40 ng/ml±21. 83 vs. 74. 82±9. 11 ng/ml),且外周血中D-乳酸(5. 38±0. 71μg/ml vs. 2. 95±0. 44μg/ml)、DAO(14. 21±1. 85μg/ml vs. 9. 07±1. 43μg/ml)、内毒素的水平(0. 17±0. 03 U/ml vs. 0. 08±0. 01 U/ml)也高于非感染组(P <0. 05)。相关性分析发现,肝硬化合并SBP患者腹水中PCT水平与IL-1β、IL-2、IL-17、IL-22、LF的水平及外周血D-乳酸、DAO、内毒素的水平均呈正相关(P <0. 05)。结论肝硬化合并SBP患者腹水PCT水平异常增加,检测腹水PCT水平可客观反映患者炎症及肠黏膜屏障受损程度。

Objective To investigate the content of procalcitonin (PCT) in ascites of patients with cirrhosis complicated with spontaneous bacterial peritonitis (SBP), and to analyze the relationship of PCT with cytokine and intestinal mucosal barrier function. Methods To retrospectively collect the data of 98 cirrhosis patients with ascites who were hospitalized in our department from July 2016 to May 2018. Patients were included SBP (n=59) and non-infected ones (n=39). The differences in the contents of PCT, inflammatory factors [interleukin-1β(IL-1β), interleukin-2 (IL-2), interleukin-17 (IL-17) and interleukin-22 (IL-22)] and lactoferrin (LF) in ascites samples as well as intestinal mucosal barrier function-related indicators [D-lactic acid, diamine oxidase (DAO) and endotoxin] in peripheral blood were compared between the two groups, and Pearson test was adopted to assess the correlation between ascites PCT content and these indicators. Results PCT in ascites of SBP patients was higher than that of non-infected patients (1.02±0.13 ng/ml vs. 0.37±0.07 ng/ml);inflammatory factors (IL-1β, IL-2, IL-17 and IL-22) and LF (155.40 ng/ml±21.83 vs. 74.82±9.11 ng/ml) in ascites samples were also higher in SBP patients. Levels of D-lactic acid (5.38±0.71 μg/ml vs. 2.95±0.44 μg/ml), DAO (14.21 μg/ml±1.85 vs. 9.07±1.43 μg/ml) and endotoxin (0.17±0.03 U/ml vs. 0.08±0.01 U/ml) of peripheral blood were higher in SBP group ( P <0.05). Correlation analysis showed that there were positive correlations between PCT and IL-1β, IL-2, IL-17, IL-22, LF, D-lactic acid DAO, endotoxin ( P <0.05). Conclusion The abnormal increase of PCT in ascites of cirrhosis patients with SBP may objectively reflect the degree of inflammation and damage of intestinal mucosal barrier.