| Background and Purpose: Spontaneous Ascitic Fluid Infection(SAI) is a newconception recently putting forward in infectious ascites of hepatic cirrhosis. It includes three types: Spontaneous Bacterial Peritonitis (SBP), Culture-negative Neutrocytic Ascites (CNNA) and (Monomicrobial Non-neutrocytic Bacterascites (MNB) . SAI is a major and severe complication in patients with cirrhotic ascites. The antibiotic therapy is the basic treatment. However, many complications such as infected shock, gastrointestinal hemorrhage, hepatorenal syndrome, hepatic failure, are often aroused as a consequence of SAI, which make it even more difficult to treatment. The reported mortality rate was about 20-40%. So it is very important to make an inquiry into pathogenesis and to probe new means to treat SAI.SAI is thought to appear as a consequence of impaired defense mechanisms against infection. An increased intestinal permeability and an impairment of intestinal function barrier play a major role in bacterial or endotoxin translocation in cirrhosis. The impairment mechanisms of intestinal function are not known very clearly. And treatments to increased intestinal permeability are explored in clinic. Our experiment was a clinical Randomized Control Trial (RCT) including 34 SAI patients of cirrhosis.The aim of this research was to evaluate the intestinal permeability, plasma and ascitic fluid levels of pro-inflammatory cytokines (TNF-a, IL-6) and endotoxin in cirrhotic ascitic patients with or without SAL We explored the role of them in the development and progression of cirrhosis. We also evaluated the therapeutic effects of Lactulose, one of prebiotcs, by changing the permeability of intestinal mucous in order to afford some new treatment for SALMethod: 34 SAI patients of cirrhosis were randomized into two groups: atreating group with lactulose including 19 cases and a control treating group including 15 cases, based on oral administration of lactulose or not. All cases were observed for 7days. In addition, 11 cirrhotic patients with sterile ascitic fluid (SA) were sorted into cirrhosis SA control group. 11 healthy cases were sorted into healthy control group. To evaluate intestinal permeability, the concentration of lactulose and mannitol in urine was measured using high-pressure liquid chromatograph with refractive index dectector (HPLC-RID),and the levels of urinary excretion of LAC/MAN ratios were caculated. The plasma and ascitic fluid levels of TNF-a, IL-6 and ET were measured with a double monoclonal sandwich enzyme linked immunosorbent assay (ELISA). ET were measured with limulus amebocyte lysate test.Date were presented as mean ?standard deviation. The methods of statistical analysis were performed with SPSS 10.0 for WINDOWS statistical package. Data were analyzed statistically with t test, analysis of variance (ANOA). Correlation was assessed by the method of Pearson correlation coefficients. There was a statistical significance when P value <0.05 occurred.Result: Among 34 cases of cirrhosis with SAI, 2 cases died, (1 case died ofhepatic encephathy ,1 cases died of shock.) 2 cases gave up treatment.1. The levels of urinary excretion of LAC/MAN ratios were significantly higher in cirrhotic patients with SAI than those without SAI in admitting hospital (P<0.05). And they were higher in cirrhosis with SAthan those in healthy control group (P<0.05)2. The plasma and ascitic levels of TNF-a, IL-6 and ET were significantly higher in liver cirrhosis patients with SAI than those in SA group in admitting hospital (P<0.05). And they were higher in cirrhosis with SAthan those in healthy control group (P<0.05)3. After being treated for one week, the levels of urinary excretion of LAC/MAN ratios, the plasma and ascitic levels of TNF-a, IL-6 and ET of cirrhotic patients with SAI were significantly decreased but only to the levels of those patients without SAI(P<0.05) .4. The levels of TNF-a, IL-6 and ET of ascites in SAI groups were higher than those of plasma, but there was no signif... |
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