Nötrositik asitli siroz hastalarında serum ve asit sıvısı TNF-alfa, interlökin-6, nitrik oksit ve myeloperoksidaz seviyelerinin, asit enfeksiyonu açısından tanısal ve prediktif değeri

Öz

Giriş ve Amaç: Asitli siroz hastalarında ortaya çıkan spontan asit enfeksiyonu, mortalitesi yüksek bir komplikasyondur. Çalışmamızda, spontan asit enfeksiyonu sırasında, proinflamatuvar sitokinler olan interlökin-6 ve tümör nekrozis faktör-alfanın asit sıvısı ve serumda, nitrik oksit ve myeloperoksidazın ise asit sıvısındaki düzeylerine bakıp, bu sonuçların asit enfeksiyonu açısından tanısal ve prediktif değeri olup olmadığını araştırdık. Gereç ve Yöntem: Çalışmaya alınan 40 hasta, steril asitli grup, kültür negatif nötrositik asitli grup ve spontan bakteriyel peritonitli grup olarak ayrıldı. Hastalardan başvuru anında asit sıvısı ve serum örnekleri alınarak saklandı. Daha sonra tüm olguların asit sıvısı ve serumunda immünoradyometrik yöntemle interlökin-6 ve tümör nekrozis faktör-alfa, asit sıvılarında ELISA ile myeloperoksidaz ve enzimatik yöntemle nitrik oksit düzeyleri çalışılarak üç grup birbiriyle ayrı ayrı karşılaştırıldı. Bulgular: Olguların asit sıvısı ve serum interlökin-6 düzeyi ortalaması kültür negatif nötrositik asit ve spontan bakteriyel peritonit grubunda steril asit grubundan anlamlı derecede yüksek bulunmuştur. Asit sıvısı tümör nekrozis faktör-alfa düzeyi ortalaması spontan bakteriyel peritonit grubunda steril asit grubuna kıyasla anlamlı derecede yüksek saptanırken, serum tümör nekrozis faktör-alfa düzeyi ortalamasında her üç grup arasında istatistiksel anlamlı fark saptanmamıştır. Asit sıvısı myeloperoksidaz düzeyi ortalaması kültür negatif nötrositik asit ve spontan bakteriyel peritonit grubunda steril asit grubundan anlamlı derecede yüksek bulunmuştur. Asit sıvısı nitrik oksit düzeyi ortalaması arasında ise her üç grup arasında istatistiksel anlamlı fark saptanmamıştır. Sonuç: Elde edilen bulgular, asitli siroz hastalarında, spontan asit enfeksiyonu tanısında, asit sıvısı ve serumdaki interlökin-6 ile asitteki myeloperoksidaz düzeylerinin, konvansiyonel yöntemlere yardımcı olabileceğini, nitrik oksit ve tümör nekrozis faktör-alfa değerlerinin ise tanısal açıdan uygun olmadığını düşündürmektedir.

Anahtar Kelimeler

• Asit
• interlökin-6
• tümör nekrozis faktör-alfa
• nitrik oksit
• myeloperoksidaz

Diagnostic and predictive values of serum and acid fluid TNF-alpha, interleukin-6, nitric oxide, and myeloperoxidase in patients with neutrocytic acid cirrhosis

Öz

Bacground and Aims: Spontaneous acid infection in patients with acidic cirrhosis is a complication with a high mortality rate. This study aimed to investigate the acid fluid and serum levels of proinflammatory cytokines interleukin-6 and tumor necrosis factor-alpha and acid fluid levels of nitric oxide and myeloperoxidase during spontaneous acid infection and to identify their diagnostic and predictive applicability with regard to acid cirrhosis. Materials and methods: We included 40 patients and categorized them into the following three groups: sterile acid, culture-negative neutrocytic acid, and spontaneous bacterial peritonitis. Acid fluid and serum samples were collected from patients upon admission and then stored. In all cases, acid fluid and serum levels of interleukin-6 and tumor necrosis factor-alpha were investigated by immunoradiometric method, acid fluid levels of myeloperoxidase by ELISA method, and nitric oxide levels by enzymatic method. Subsequently, these three groups were compared with each other. Results: Serum and acid fluid levels of interleukin-6 were significantly lower in the sterile acid group than in the culture-negative neutrocytic acid and spontaneous bacterial peritonitis groups. Serum interleukin-6 levels in the culture-negative neutrocytic acid and spontaneous bacterial peritonitis groups were significantly higher than those in the sterile acid group. Moreover, the acid fluid and serum tumor necrosis factor-alpha levels in the culture-negative neutrocytic acid group were significantly higher than those in the sterile acid group; however, there was no statistical difference in the intergroup serum tumor necrosis factor-alpha levels. The acid fluid levels of myeloperoxidase were also significantly higher in the sterile acid group than in the culture-negative neutrocytic acid group and spontaneous bacterial peritonitis group. We observed no significant intergroup differences with regard to the nitric oxide levels in acid fluid. Conclusion: In chronic liver parenchyma patients with neutrocytic acid cirrhosis, acid fluid and serum levels of interleukin-6 and acid fluid levels of myeloperoxidase may help the conventional methods in diagnosing spontaneous acid infection; however, the serum levels of nitric oxide and tumor necrosis factor-alpha have no diagnostic value. Key words: , , , , myeloperoxidase.

Anahtar Kelimeler

• Ascite
• interleukin-6
• tumor necrosis factor-alpha
• nitric oxide
• myeloperoxidase

Kaynakça

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