The Significance Of Serum TNF-ɑ And CRP Determination In Patients With Hepatorenal Syndrome

【Objective】Hepatorenal syndrome(HRS) is a common and severe complication in advanced liver disease. It is well-known that its key pathogenesis may be the renal vasoconstriction secondary to peripheral arterial vasodilation. Recently studies have showed that tumor necrosis factor-α(TNF-α) would mediate the portal and systemic haemodynamic derangements, and enhance the renal vasoconstriction. C-reactive protein(CRP) have become a useful marker for early assessing the development and prognosis of cardiovascular diseases and renal failure. TNF-αpromotes the synthesis of CRP by induction of interleuin-6(IL-6). But there is no study on TNF-αand CRP in patients with HRS so far. Therefore, the aim of this study is to investigate serum levels of TNF-αand CRP in cirrhotic patients with varied renal dysfunction, and explore their role in the development and progression of HRS and clinical significance. 【Methods】Ninety cirrhotic patients were divided into 3 groups according to renal function assessed by creatinine clearance(Ccr): ①group-1(simple cirrhotic patients): Ccr≥80ml·min^-1·1.73m^-2 (n=43), ②group-2(subclinical HRS patients): Ccr within 40–80 ml·min^-1·1.73 m^-2 (n=28), and ③group-3(HRS patients): Ccr< 40ml·min^-1·1.73m^-2(n=19). In all the cirrhotic patients and 26 healthy volunteers(normal control), their serum TNF-αand CRP were measured by means of Enzyme-linked immunoabsorbent assay (ELISA). Serum creatinine(Scr), blood urea nitrogen(BUN), liver function, prothrombin time and Ucr and were assayed. Scr, Ucr and BUN were detected on the automated clinical biochemistry system (HITACHI 7600-010) with Jaffe method and UV-GLDH method, respectively. According to Child-pugh classification, 26, 40 and 24 cirrhotic patients were in Group A, B and C respectively. 【Results】1. The serum TNF-αlevels(70.76±57.26ng/l) in cirrhotic patients were significantly higher than those in normal controls(13.53±6.70 ng/l) (P<0.01). Furthermore, the serum TNF-αlevels were elevated in patients gradually from Child-pugh A, through Child-pugh B, to Child-pugh C( P<0.01). 2. The serum CRP levels(34.59±25.12mg/l) in cirrhotic patients were significantly higher than those in normal controls(5.45±5.05mg/l) (P <0.01). Furthermore, the serum CRP levels were elevated in patients gradually from Child-pugh A, through Child-pugh B, to Child-pugh C( P<0.01). 3. The serum TNF-αlevels increased gradually from group-1(33.09±15.75 ng/l), through group-2(65.15±36.66 ng/l), to group-3(114.78±80.88 ng/l)(all P<0.01). Serum TNF-αconcentrations inversely correlated with the Ccr (r=-0.637,p<0.01). 4. The serum CRP levels increased gradually from group-1(20.95±17.00 mg/l), through group-2(32.42±24.50 mg/l), to group-3(50.77±24.53 mg/l) (all P<0.01). Serum CRP concentrations inversely correlated with the Ccr(r=-0.631,p<0.01). 5. Scr concentrations in group-3 were markedly higher than those in normal controls, group-1 and group-2, but there were no statistically differences among the later three groups; Scr concentrations inversely correlated with the Ccr(r=-0.395, P<0.01). 6. Serum CRP concentrations in cirrhotic patients positively correlated with the serum TNF-αconcentration (r=0.734, P<0.01). 7. Serum CRP concentrations in cirrhotic patients were inversely associated with the serum albumin concentration (r=-0.231,P<0.05).【Conclusions】1. The renal dysfunctions in cirrhotic patients exacerbate as the serum TNF-αlevels increase. TNF-αmay play an important role in the development and progression of HRS. 2. The elevated serum CRP levels in cirrhotic patients are inversely correlated with their renal dysfunction. So it may reflect the severity of HRS. And it can add evaluating or prognostic information to HRS. 3. The serum levels of TNF-αand CRP are closely associated with severity of liver cirrhosis. Therefore they may contribute to assess the progression of liver cirrhosis and predict its complications.