| Background and ObjectiveCirrhosis is a common disease of internal medicine, which is the advanced stage of various chronic liver diseases. Liver cirrhosis patients who are at decompensation stage often occur hepatic failure, portal hypertension and a variety of complications, with extremely high mortality rates. Spontaneous bacterial peritonitis (SBP) is the bacterial infection of peritoneum and (or) ascites in the absence of any neighboring inflammatory response and perforation of intra-abdominal organs. SBP is one of the common serious complications with the incidence rate of about 10% to 30% among cirrhotic patients with ascites, which is also closely related to the complications, such as hepatic encephalopathy, hepatorenal syndrome, and so on. SBP is one of the key factors leading to aggravate the condition or to death and affects the prognosis of liver cirrhosis patients seriously. Most liver cirrhosis patients who are at decompensation stage exist factors that are prone to occur bacterial translocation (BT), such as increased intestinal permeability, intestinal bacterial overgrowth (IBO) and alterations of intestinal flora, dysfunction of local and (or) systemic immune defence, portosystemic shunts, and so on. Translocated bacteria and their products (such as endotoxin) can activate immune cells and further induce the reaction of inflammatory cytokine cascade network, which play an important role in the pathogenesis and development of SBP. IL-18 which was discovered in recent years is an important pro-inflammatory cytokine and plays an important role in infectious diseases and inflammatory response. Both IL-18 and IL-10 can be produced by endotoxin activated macrophages. IL-18 can promote Thl cell differentiation, induce Thl and NK cells to produce IFN-γ, TNF-a and other inflammatory mediators, induce Fas ligand-mediated cytotoxic effects. IL-10 is an anti-inflammatory cytokine which have been well studied and plays a role in resisting to infection. IL-10 can inhibite the production of TNF-a and other inflammatory mediators, inhibite the release of reactive oxygen species, inhibit the aggregation of inflammatory cells, up-regulate sILIRa and soluble TNF-αreceptors thus inhibits the activation of macrophages.Levels of pro-inflammatory cytokines increased in serum and ascites of SBP patients. However, there are few reports about anti-inflammatory cytokines. Researchs on IL-18 are mainly about its roles in infectious diseases, cancers and autoimmune diseases, but rare in SBP. The aim of the study is to investigate the levels of IL-10 and IL-18 in serum and ascites of liver cirrhosis patients complicated with SBP and probe into their roles and clinical significance in the pathogenesis and development of SBP. To explore the pathogenesis of SBP and provide new methods and theoretical basis for clinical diagnosis and treatment.Methods1 Serum and ascites levels of IL-10 and IL-18 were assayed by ELISA in 32 sterile ascites (SA) patients and 45 SBP patients. After being treated with cefoperazone tazobactam combined with ornidazole for 10 days, the indicators were re-reviewed in SBP patients. Only serum-related indicators were assayed in control group, which was composed of 20 healthy individuals.2 Statistical analysis:All the data were analyzed by SPSS 16.0 statistical package. Numerical variables were represented by x±s. The comparision of quantitative datas using two independent samples t test, paired t test and the q test of ANOVA analysis, while the comparision of qualitative datas usingχ2 test and rank sum test. The significance level wasα=0.05. Results1 Serum and ascites levels of IL-10 and IL-18 in SBP and SA patients were significantly higher than that in healthy individuals (180.422±84.789pg/ml, 455.781±106.750pg/ml vs 36.065±10.181pg/ml,P<0.01; 744.378±249.160pg/ml, 571.094±157.501pg/ml vs 82.850±31.101pg/ml,P<0.01).2 SBP patients had higher levels of IL-18(especially ascites level of IL-18) (744.378±249.160 pg/ml vs 571.094±157.501pg/ml,P<0.01,1005.467±286.552 pg/ml vs 798.781±212.454pg/ml,P<0.01)but lower levels of IL-10 compared with that of SA patients(180.422±84.789pg/ml vs 455.781±106.750pg/ml, P<0.01,579.711±246.260pg/ml vs 736.063±265.414pg/ml, P<0.05).3 Levels of IL-10 and IL-18 in ascites of SBP patients were higher than those in serum (579.711±246.260pg/ml vs 180.422±84.789pg/ml, P<0.01; 1005.467±286.552pg/ml vs 744.378±249.160pg/ml, P<0.01), while there was no significant difference in ascites and serum of SA patients(455.781±106.750pg/ml vs 736.063±265.414pg/ml, P>0.05; 571.094±157.501pg/ml vs 798.781±212.454pg/ml, P>0.05).4 Serum and ascites levels of IL-10 and IL-18 decreased significantly after therapy in SBP patients(155.600±73.631pg/ml vs 180.422±84.789 pg/ml, P<0.01, 249.510±100.362pg/ml vs 579.711±246.260pg/ml, P<0.01;610.133±250.682pg/ml vs 744.378±249.160pg/ml, P<0.01,811.020±287.916pg/ml vs 1005.467±286.552pg/ml, P<0.01), but the decrease was more significant in ascites than that in serum.5 Child-pugh classification and Child-pugh score both decreased significantly after therapy (Z=-6.97, P<0.01; 8.79±0.41 vs 6.71±0.80,t=27.89, P<0.01).Conclusions1 IL-10 and IL-18 play important roles in the pathogenesis and development of SBP.2 The imbalance between pro-inflammatory cytokines and anti-inflammatory cytokines may be related to the occurrence and development of SBP. 3 Detection of ascites levels of IL-10 and IL-18 are of certain guiding significance for diagnosis, evaluate the efficacy and predict the prognosis of SBP. |
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