肝硬化腹水时细胞因子水平测定的临床应用研究  

Study about clinical use on changes of cytokines in serum and asciteds in liver cirrhosis patients with spontaneos peritonitis

作　　者：韩大正[1] 李秋波[1] 魏君锋[1] 

机构地区：[1]河南大学第一附属医院消化内科,河南开封475001

出　　处：《中国现代医学杂志》2005年第23期3566-3568,共3页China Journal of Modern Medicine

基　　金：河南省科技攻关项目.开封市科技进步二等奖(No:001170629)

摘　　要：目的探讨肝硬化腹水及并发自发性细菌性腹膜炎时,血清及腹水中细胞因子水平的变化特点,从而指导临床使用抗生素。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+药敏,所有肝硬化腹水患者均同时作血清及腹水一氧化氮、肿瘤坏死因子、内毒素水平检测。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测定NO、TNFa、LPS,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,指导临床用药。[Objective] To study the changes of cytokines in serum and ascites in liver cirrhosis patients with ascites and spontaneous peritonitis so as to instruct 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 bacterium 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 level in the serum and ascites of the exudative ascites patients which liver cirrhosis are obviously higher than that of tuansudate ascites patients with liver cirrhosis; NO, TNFa, LPS level in the serum and ascites of exudative ascites patients with liver cirrhosis that infected in Gram-positivebacteria are obviously higher than that in Gram-negativebacteria. [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 is infected in Gram-positivebacteria and Gram-negativebacteria so as to instruct clinical use of drugs.

关 键 词：肝硬化 自发性腹膜炎 细胞因子 革兰阴性菌 革兰阳性菌 

分 类 号：R657.31[医药卫生—外科学]