The Related Reaserch Between Hepatic Cirrhotic Patients With Ascites Complicated With Spontaneous Bacterial Peritonitis And MCP-1

Objective:To investigate the correlation between spontaneous bacterial peritonitis(SBP)in hepatic cirrhotic ascites and MCP-1,and search for a sensitive and specific clinical index for early diagnosis of SBP in patients with hepatic cirrhotic ascites.To evaluate the application value of MCP-1 in SBP in hepatic cirrhotic ascites.It provides a basis for prevention and individualized treatment of the diseases.It has important clinical significance for reducing the prevalence of SBP in cirrhotic ascites and improving the prognosis of patients to explore the risk factors of SBP in patients with cirrhosis ascites.Methods:A total of eighty hospitalized patients suffered with hepatic cirrhotic ascites from December 2015 to July 2017 in Sixth People's Hospital of Dalian were selected.They were divided into 40 cases of patients with SBP(SBP group)and 40 cases of patients without SBP(non-SBP group).For the control group,30 healthy out patients under went physical examination during the same period(healthy control group).Clinical data of all the patients were collected.The peripheral venous blood and asctites were obtained from patients enrolled before treatment,peripheral venous blood were obtained from the healthy control group.Restriction endonuclease(Pru II)digestion was used to detect the MCP-1promoter(A-2518G)gene polymorphism.The expression of MCP-1 in peripheral serum and ascites was detected by Enzymelinked Immunosorbent Assay(ELISA).To analyze the relationship between clinical indicators and SBP in cirrhosis ascites by statistical method.The correlation between MCP-1 promoter(A-2518G)gene polymorphism,MCP-1concentration in serum and hepatic cirrhotic ascites complicated with SBP was analyzed.Evaluate the effect of etiology(post hepatitis B cirrhosis,alcoholic cirrhosis)on the expression of MCP-1 in serum and ascite by subgroup analysis.Receiver operating characteristic(ROC)curves were used to evaluate the diagnostic value of the markers.Study the correlation between MCP-1 and clinical indicators at the same time.Results:1.Comparison of general information between two patient groups:The general information assessment shows that there was no significant difference in age,sex,alanine aminotransferase(ALT),aspartate aminotransferase(AST)and prothrombin time(Prothrombin time,PT)between the two patient groups(P>0.05);the levels of albumin(Al b)and sodium in serum in SBP group were lower than in non-SBP group(P<0.05);Child-Pugh classification,the levels of total bilirubin(TBil),leukocyte(WBC),neutrophil ratio(N%),procalcitonin(PCT),levels of MCP-1 in serum,polymorphonuclear(PMN)),MCP-1 in ascite in SBP group were significantly higher than those in non-SBP group(P<0.05).2.Genotypes of MCP-1 promoter(A-2518G)loci :(1)the frequency of AG genotype in SBP group was significantly higher than those in non-SBP group and healthy control group(P<0.05);(2)the frequency of GG genotype in non-SBP group was significantly higher than that in SBP group and healthy control group(P<0.05);(3)the frequency of G allele in SBP group and non-SBP group was significantly higher than that in healthy control group(P<0.05),the frequency of G allele in non-SBP group was higher than that in SBP group(P<0.05);(4)the frequency of allele A in SBP group was higher than that in non-SBP group(P<0.05).3.Subgroup analysis according to etiology(post hepatitis B cirrhosis,alcoholic cirrhosis)showed no significant difference in levels of MCP-1 in serum and ascites(P>0.05).By calculating the area under receiver operating characteristic curves(AUC),analysis showed that the AUCs for MCP-1 in serum and ascites were0.923(95(4)CI was 0.864-0.981),0.931(95(4)CI was0.930-0.999).It has higher accuracy in the diagnosis of hepatic cirrhoticascites complicated with SBP.At this time,by using the Youden Index method calculated,the optimal cut-off value of MCP-1 in serum was 272.34pg/ml,MCP-1 in ascites was 121.18ng/m L;respectively,MCP-1 in serum:sensitivity=90%,specificity=85%,MCP-1 in ascites sensitivity=90%,specificity=92.5%.4.Person correlation analysis showed that levels of MCP-1 in serum and ascites were negatively correlated with concentration of Alb(P<0.05),MCP-1 in serum and ascites sodium in serum(P<0.01),werepositively correlatedwith leukocyte count,N% in blood,PCT,PMN in ascites,the difference was statistically significant(P<0.01).Conclusion:1.Alb,sodium in blood,Child-Pugh classification,TBil,WBC,N%,PCT,MCP-1 in serum,PMN in ascites,and MCP-1 in ascites are the risk factors of SBP in hepatic cirrhotic ascite.2.The MCP-1 promoter(A-2518G)gene polymorphism may be involved in the development of SBP in hepatic cirrhotic ascites through affecting the expression of MCP-1.MCP-1 is expected to become a clinical indicator for early diagnosis of SBP in hepatic cirrhotic ascites.3.The findings implied that a correlation among concentrations of MCP-1 in serum and ascites and Alb,sodium in blood,WBC,N%,PCT and PMN in ascites.