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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 the expression of proinflammatory cytokines such as tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in patients with cirrhosis spontaneous bacterial peritonitis (SBP) and cirrhosis with aseptic ascites ) Level and the clinical significance of change. Methods A total of 188 patients with hepatic cirrhosis and ascites (including cirrhosis and spontaneous bacterial peritonitis (SBP)) were enrolled in this study. Serum cirrhosis with aseptic ascites (SA group) was detected by double antibody sandwich enzyme-linked immunosorbent assay (ELISA) ), 110 cases of ascites and blood samples were collected, and the level of TNF-α and IL-6 in the ascites and blood samples were detected. In the same period, 20 healthy subjects were used as healthy control group, and the levels of LPS, TNF-α and IL-6 in three groups were compared. Results The levels of LPS, TNF-α and IL-6 in SBP group and SA group were significantly higher than those in healthy control group (P <0.001). The concentrations of LPS, TNF-α and IL-6 in ascites of SBP group were significantly higher than those in SA group P <0.001). The levels of plasma endotoxin and TNF-α and IL-6 in patients with cirrhosis were positively correlated (P <0.05). Conclusions There is endotoxemia in patients with liver cirrhosis and ascites, and elevated levels of TNF-α and IL-6 in patients with ascites due to hepatitis and cirrhosis are related to the increase of endotoxin levels in patients with liver cirrhosis.