肝硬化自发性腹膜炎时血清及腹水中细胞因子水平研究  

Study on serum variation of Liver cirrhosis patients with spontaneous peritonitis and cytokines in ascites

作　　者：韩大正[1] 张玉兰[1] 袁玉莲[1] 翟秀玲[1] 李秋波[1] 

机构地区：[1]河南大学东京医院消化内科,河南开封475001

出　　处：《河南大学学报（医学科学版）》2004年第2期7-9,14,共4页

基　　金：河南省科技厅科技攻关项目 (0 0 1 1 70 6 2 9)

摘　　要：目的 :探讨肝硬化革兰阴性菌与革兰加阳性菌感染引起的自发性腹膜炎时 ,血清及腹水中细胞因子水平的变化特点 ,从而指导临床合理抗生素。方法 :肝硬化腹水患者常规作腹水检查 ,以区别渗出性腹水或漏出性腹水 ,对渗出性腹水患者均作细菌培养加药敏实验 ,所有肝硬化腹水患者均同时作血清及腹水一氧化氮 (NO)、肿瘤坏死因子 (TNFa)、内毒素 (LPS)水平检测。结果 :肝硬化伴渗出性腹水患者外周血及腹水中NO、TNFa、LPS水平明显高于肝硬化伴漏出性腹水患者 ;肝硬化革兰阴性菌感染引起的自发性腹膜炎时 ,腹水中NO、TNFa、LPS水平显著高于革兰阳性菌感染引起的腹水。结论 :肝硬化腹水患者血清及腹水中NO、TNFa、LPS测定 ,有助于鉴别渗出性腹水和漏出性腹水 ;有助于鉴别自发性腹膜炎是革兰阴性菌或革兰阳性菌感染引起 。Objective: To study on serum variation of Liver cirrhosis patients with spontaneous peritonitis and cytokines in ascites caused by Gram-positive bacteria or by Gram-negative bacteria, so as to insturct clinical use of antibiotics.Methods: Ascites of the patients with liver cirrhosis were carried out routine test to distinguish between exudative ascites and transudate ascites. All patients with exudative ascites had bacteria cultured and drug-effective tested in their ascites. At the same time, Nitric oxide(NO), Tumor Necrosis Factor-a(TNFa), LPS were tested in the serum and ascites of all patients with liver cirrhosis ascites.Results: NO, TNFa, LPS levels in the serum and ascites of the exudative ascites patients with liver cirrhosis were obviously higher than those in the serum and ascites of transudate ascites patients with liver cirrhosis. NO, TNFa, LPS levels in ascites infected by Gram-positive bacteria were obviously higher than those by Gram-negative bacteria. Conclusion: Test of NO, TNFa, LPS in the serum and ascites of the patients with liver cirrhosis ascites can contribute to distinguishing between exudative ascites and transudate ascites, and distinguishing between spontaneity peritonitis infected by Gram-positive bacteria and by Gram-negative bacteria so as to instruct clinical use of drugs.

关 键 词：肝硬化 自发性腹膜炎 血清 腹水 细胞因子 革兰阴性菌 革兰阳性菌 

分 类 号：R575.2[医药卫生—消化系统] R572.2[医药卫生—内科学]