自发性腹膜炎患者腹水中IL-18的表达水平及临床意义

Expression level of IL-18 in ascites of patients with spontaneous bacterial peritonitis and its influencing factors

摘要:

摘要：目的  探讨自发性腹膜炎患者腹水中白介素18（IL-18）的表达水平及其影响因素。方法  前瞻性选取2014年1月-2016年1月浙江省宁波市鄞州人民医院和浙江大学医学院附属第一医院收治的乙型肝炎性肝硬化合并腹水患者231例，根据患者是否发生自发性腹膜炎将患者分为观察组（41例）和对照组（190例），检测两组患者腹水中IL-18水平，并分析IL-18的临床意义及影响因素。结果  与对照组比较，观察组患者腹水中IL-18水平升高（P <0.05）。多因素Logistic回归分析显示，腹水中IL-18水平升高是乙型肝炎性肝硬化患者自发性腹膜炎的危险因素[■=1.32（95%CI：1.14，1.50）P =0.000]。多元线性回归分析显示，腹水中白介素6（IL-6）、肿瘤坏死因子-α（TNF-α），以及血清CD4+ T细胞、TNF-α、IL-6、IL-18水平是影响腹水中IL-18水平的因素（b=0.362、0.318、0.253、0.247、0.262和0.427）。结论  腹水中IL-18水平升高是乙型肝炎性肝硬化患者自发性腹膜炎的危险因素；腹水中IL-6、TNF-α，以及血清CD4+ T细胞、TNF-α、IL-6、IL-18水平是腹水中IL-18水平的影响因素。

Abstract:

  Abstract: Objective To investigate the level of interleukin-18 (IL-18) in ascites of patients with spontaneous bacterial peritonitis and its influencing factors. Methods From January 2014 to January 2016, 231 cases of hepatitis B cirrhosis with ascites were prospectively collected from Yinzhou People's Hospital and the First Affiliated Hospital of Medical College, Zhejiang University. According to whether the patients developed spontaneous bacterial peritonitis or not, the patients were assigned into the observational group (n = 41) or the control group (n = 190). The level of IL-18 of ascites was detected in both groups, and the clinical significance and influencing factors of IL-18 were analyzed. Results Compared with the control group, the IL-18 level of the patients in the observation group was significantly increased (P < 0.05). Multivariate regression analysis showed that IL-18 was the risk factor for spontaneous bacterial peritonitis in the patients with hepatitis B cirrhosis [■ = 1.32 (95% CI: 1.14, 1.50), P = 0.000]. Multiple linear regression analysis showed that interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) of the ascites and serum CD4+ T cell, TNF-α, IL-6 and IL-18 were the factors influencing the IL-18 level in ascites (b = 0.362, 0.318, 0.253, 0.247, 0.262 and 0.427). Conclusions Increased level of IL-18 in ascites is the risk factor for spontaneous bacterial peritonitis in patients with hepatitis B cirrhosis. IL-6 and TNF-α in ascites and serum CD4+ T cell, TNF-α, IL-6 and IL-18 are the factors influencing IL-18 level in ascites.