The Changes And Significance Of HO-1 In Serum And Ascites Of Patients With Liver Cirrhosis Complicated With SBP

Background and Objective:Spontaneous bacterial peritonitis is a serious complication in patients with liver cirrhosis.Early detection and effective early application of antimicrobial agents are closely related with the prognosis with SBP.In rencent years,a large number of studies have found that HO-1,as an important oxidative stress response protein in human body,can delay the disease progression of SBP by reducing intestinal bacterial translocation and inhibiting the release of inflammatory factors.owever,the current research on the correlation between HO-1 and SBP is limited to animal experiments and in vitro models.The purpose of the study is to observe the changes of serum and ascites levels of HO-1 in patients with liver cirrhosis complicated with SBP,explore the correlation between the level of HO-1 and the severity of SBP,in order to obtain sensitivity biological markets to the assessment of SBP and evaluate the predictive value of HO-1,provide a theoretical basis for its early intervention.Methods:60 patients with liver cirrhosis complicated with ascites were included,in our hospital from From November 2019 to November 2020.Collected the general information,past medical history and biochemical indexes.At the same time,the serum and ascites of the above patients were collected,and the content of HO-1 was detected by ELISA.According to the relevant diagnostic criteria of Guidelines on the management of ascites and complications in cirrhosis,they were divided into liver cirrhosis with SBP group and liver cirrhosis with simple ascites group.The differences of HO-1 content in serum and ascites between the two groups were compared,and the correlation between HO-1 content and disease condition and SBP influencing factors was analyzed,so as to explore the diagnostic significance of HO-1 content in serum and ascites for patients with SBP.Results:1.According to the inclusion and exclusion criteria,a total of 60 patients with liver cirrhosis complicated with ascites were included,including 34 patients with simple ascites and 26 patients with SBP.There was no significant difference in age and gender between the two groups.WBC,NEUT%,ALB,TBIL,SCR,Na,PCT,IL-6,CRP,ascites leukocytes and ascites PMN have significant difference(P<0.05).2.The level of HO-1 in serum and ascites of patients with SBP were higher than patients with simple ascites,and there was a significant difference(P<0.001).3.There was no significant difference in HO-1 levels among patients with SBP of different causes and ascites bacteria culture(P>0.05).The levels of HO-1 in serum and ascites of CP-C patients was significantly decreased(P<0.05).4.In patients with Child-Pugh B,serum HO-1 was negatively correaled with AST(r=-0.394,P=0.046),ALP(r=-0.451,P=0.020),TBIL(r=-0.510,P=0.007),positively correaled with IL-6(r=0.684,P<0.001),PCT(r=0.983,P<0.001),but no correlation with serum WBC,NEUT%,ALT,PTA,ALB,Scr,Na,and ascites WBC,PMN.Ascites HO-1 levels decreased with increasing of serum TBIL(r=-0.450,P=0.021),and were posotively correlated with IL-6(r=0.712,P<0.001),PCT(r=0.888,P<0.001),ALB(r=0.546,P=0.004),And acties WBC(r=0.415,P=0.035),PMN(r=0.827,P<0.001),There were no correlation with WBC,NEUT%,ALT,AST,ALP,PTA,Scr,Na(P>0.05).In patients with Child-Pugh C,serum HO-1 was negatively correaled with TBIL(r=-0.724,P<0.001),Scr(r=-0.457,P=0.019),IL-6(r=-0.532,P=0.005),PCT(r=-0.745,P<0.001),but no correlation with serum WBC,NEUT%,ALT,AST,ALP,PTA,ALB,Scr,Na,and ascites WBC,PMN.Ascites HO-1 levels decreased with increasing of serum ALT(r=-0.431,P=0.028),IL-6(r=-0.674,P<0.001),PCT(r=-0.820,P<0.001)and acites WBC(r=-0.391,P=0.048),PMN(r=-0.651,P<0.001),and were negatively correlated.There were no correlation with serum WBC,NEUT%,AST,ALP,TBIL,PTA,Scr,Na.5.In patients with liver cirrhosis complicated with SBP,Serum HO-1 was positively correalted with ascites HO-1,the r values of CP-B and CP-C patients were0.692,0.475(P<0.05).6.The AUC of serum HO-1 is 0.897,the standard error is 0.045,and the 95%confidence interval is(0.808,0.986).The serum HO-1 threshold is 53.03ng/ml,the sensitivity is 84.6%,and the specificity is 94.1%.The AUC of ascites HO-1 is0.825,the standard error is 0.059,and the 95% confidence interval is(0.708,0.941).The serum HO-1 threshold is 22.08ng/ml,the sensitivity is 79.2%,and the specificity is 83.3%.Conclusion:1.The content of HO-1 in serum and ascites increased synchronously in patients with liver cirrhosis complicated with SBP and played a protective role,but its protective role could be exhausted with the progress of the disease.2.The level of HO-1 in serum and ascites is closely related to the disease progression of SBP,which can be used as a biological indicator for SBP prediction,and the diagnostic efficiency of serum HO-1 is better than ascites HO-1.