| Objective:Spontaneous bacterial peritonitis (SBP) frequently develops in patients with decompensated liver cirrhosis or sever viral hepatitis (especially chronic and subacute sever viral hepatitis), with an incidence of8.4-24.7%. Patients with ascites have an increased susceptibility to spontaneous bacterial peritonitis, leading to poor prognosis and high mortality rates. Clinical manifestations are usually slight or absent due to ascites and poor reaction of the patient. But the culture of ascites is time-consuming and low positive rate, leading to high rate of missed diagnosis misdiagnosis at the early stage and poor prognosis. The serum levels of MCP-1、TNF-a、IL-10were observed in hepatitis B virus-related liver cirrhosis patients with or without spontaneous bacterial peritonitis. And the variation of serum MCP-1、TNF-a、IL-10expression were detected in those patients on admission and after treatment7days later. The aim of this research is to evaluate the possible role of MCP-1、 TNF-a、IL-10levels in serums for prediction of early diagnosis and prognosis with the diagnostic equation method.Methods:17patients with hepatitis B virus-related liver cirrhosis with ascites were randomly selected in the third hospital affiliated to central south university from March,212to November,2012. SBP diagnosis is based on testing of the ascitic fluid obtained by paracentesis, according to the2010guideline on prevention and treatment of chronic hepatitis B in China and Clinical Hepatology. There were20hepatitis B virus-related liver cirrhosis patients with spontaneous bacterial peritonitis (SBP group),20hepatitis B virus-related liver cirrhosis patients without spontaneous bacterial peritonitis (N-SBP group). Both on admission and after treatment7days later, Blood was taken for determination of blood cell count, coagulating function, liver and kidney function, MCP-1、 TNF-a、IL-10and so on. And ascites was taken for determination of Ascites cell count and culture.Results:1.TNF-a、MCP-1and IL-10serum levels were (12.19±2.71) pg/mL、(373.87±147.47) pg/mL and (2.15±0.92) pg/mL in patients of SBP group, significantly higher than that in N-SBP group[(8.71±1.75) pg/mL、(191.4±89.77) pg/mL and (1.36±0.47) pg/mL (P<0.05)].2.In SBP group, TNF-a、MCP-1and IL-10serum levels were (12.19±2.71) pg/mL.(373.87±147.47) pg/mL and (2.15±0.92) pg/mL on admission, significantly higher than that after treatment7days later [(8.71±1.75) pg/mL.(232.94±55.59) pg/mL and (1.36±0.47) pg/mL (P<0.05)].3.Significant associations of the level of WBC、N、TBTL、DBIL、ALB、 TNF-a、MCP-1and IL-10on admission with diagnosis of SBP were found. The correlation cofficient was0.332、0.308、0.405、0.405、0.385、0.544%、0.520、0.550seprately.4.The logit regression model showed that the level of serum MCP-1and IL-10on admission were the best predictors of early diagnosis and outcome in SBP. We formed the diagnostic equation of SBP:Logit P=-10.922+0.029X serum MCP-1+1.707×serum IL-10, if≥1, it is not likely to be SBP, if<1, SBP should be considered. The sensitivity、specificity and accuracy are all90%. Conclusions:1.TNF-a、MCP-1and IL-10serum levels in patients of SBP group were significantly higher than that in N-SBP group. Those cytokines were predictors of early diagnosis of SBP.2.After treatment7days later, TNF-a、MCP-1and IL-10serum levels in patients of SBP group were significantly decreased. Those cytokines were helpful to indicate the efficacy of anti-infective therapy in SBP.3.The logit regression model showed a diagnostic equation of liver Cirrhosis with ascites: Logit P=-10.922+0.029X serum MCP-1+1.707X serum IL-10, if≥1, it is not likely to be SBP; if<1,SBP should be considered. |
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