الفهرس 
AscitesOnly 14 pages are availabe for public view
 |  | from | 81 |  |  |
| | | from | 81 | | |
Abstract
Mannose-binding lectin (MBL) is a serum calcium-dependent protein synthesized by the liver. It is one of the most important components of innate immunity as it provides first line of defense by its ability to bind sugar residues on the bacterial surface through its carbohydrate recognition domain and activates the complement pathway leading to lysis of bacteria independent of antibody. The serum MBL level is variable in healthy population. It is known now that the mean serum MBL level in an individual is genetically determined by three single nucleotide substitutions in exon-1 of the human MBL gene located at codons 52, 54 and 57 also referred as D, B, and C mutations whereas the wild type allele is referred as A. MBL deficiency has been implicated in susceptibility and course of viral, bacterial, fungal, and protozoan infection and it binds to a range of clinically relevant pathogens but the clinical manifestation of MBL deficiency seems to be of greater significance either when immune system is still immature as in infancy or when there is an associated immunodeficiency. Cirrhosis which is considered the third leading cause of death in patients aged 45 to 65 (after cardiovascular disease and cancer) in Western world results in major complications such as portal hypertension with variceal bleeding, ascites, SBP or liver failure leading to renal failure and coma. It has been said that cirrhosis is the most common form of immunodeficiency. Infectious complications in cirrhotic patients can cause severe morbidity and mortality. Spontaneous bacterial peritonitis is an acute bacterial infection of ascitic fluid. Generally, no source of the infecting agent is easily identifiable; it is a severe and frequent complication of cirrhosis with a high mortality rate. The aim of this study is to evaluate the role of mannose binding lectin in cirrhotic patients with and without spontaneous bacterial peritonitis and determine its role in diagnosis of peritonitis. The study was carried out during the period from February 2012 to April 2013 in the National Liver Institute, Menofiya University; it was conducted on 90 individuals, whom were classified into three groups, Group 1: 35 patients (cirrhotic with SBP) , Group 2: 35 patients (cirrhotic without SBP) and Group 3: 20 persons as a control. Serum level of MBL was done to all individuals by ELISA, ascitic fluid culture and biochemistry, TLC and liver function tests were done to all patients. The results obtained were collected, tabulated and submitted for statistical analysis. The following results were obtained: • There was no significant difference regarding age and sex distribution among studied groups. • Fever and abdominal pain were the prominent clinical presentation in cirrhotic patients with SBP while tense abdomen was present in all cirrhotic patients without SBP. • Level of serum albumin was significantly lower in patients than in control, while level of AST, ALT, serum bilirubin and WBCs were significantly higher in patients than in control. • Prothrombin time was significantly longer in patients of cirrhosis without SBP. • TLC and LDH of the ascitic fluid were significantly higher in cirrhotic patients with SBP than in cirrhotic patients without SBP while glucose level was significantly lower in cirrhotic patients with SBP. • Most patients in the study were classified according to severity of liver disease to CHILD B. • Serum level of MBL was significantly lower in cirrhotic patients with SBP than in those without SBP while significantly higher in the latter group than control. We found that 2 cases of cirrhotic patients with SBP had absolute MBL deficiency (MBL< 100ng/ml). There was no significant difference between studied groups regarding age and sex in relation to serum level of MBL. When comparing serum level of MBL of the studied groups with their laboratory data (serum albumin, bilirubin (total & direct), WBCs, ALT, and AST: we found that there was no significant correlation except with AST there was significant positive correlation. Significant positive correlation was found between serum level of MBL and CHILD classification. Significant positive correlation between level of albumin and total protein of the ascitic fluid and serum level of MBL while significant negative correlation with the latter and TLC, glucose level in ascitic fluid and no significant difference regarding LDH. The ROC curve showed that the cutoff point for diagnosis of cases of SBP from non SBP is (1202.5 ng/ml) with a sensitivity of (71.4%), p value <0.001(significant). from cirrhotic cases with SBP (42.9%) were culture positive, E.coli was the predominant isolated bacteria (53.3%) followed by Klebsiella (13.3%). Other Gram negative bacteria isolated were Acinetobacter and Aeromonas also Gram positive bacteria isolated were Staph. aureus, Staph epidermidis and Streptcocci. Regarding bacterial sensitivity to antibiotics we found that 40% (4/10) of cases of E.Coli and Klebsiella were extended-spectrum β-lactamase producing (ESBL-EK). The only isolated case of staph aureus was a methicillin- resistant Staph aureus. Serum level of MBL was significantly lower in culture positive ascitic fluid than culture negative samples and also significantly lower in Gram negative isolates than Gram positive ones. from the present study it was concluded that: 1. The results obtained for MBL concentration by ELISA Method are accurate and could be correlated with clinical expressions. 2. Serum level of MBL in control group made us conclude that large inter-individual variations in serum MBL levels are well-documented in healthy persons, but individual values are very stable over time, largely due to their genetic disposition so we should have a baseline level of serum MBL for each individual to compare its level in health and disease. 3. Low serum level of MBL in cirrhotic patients was associated with more susceptibility to infection (SBP) due to defective immune response so it has a predictive value for SBP in cirrhotic patients. 4. Patients with elevated levels of serum MBL than control suffered from high degree of cirrhosis and most of them were CHILD C and this matched the fact that MBL is an acute phase reactant. 5. Culture of ascitic fluid by inoculating ascitic fluid of cirrhotic patients into blood culture bottles at bedside should be performed replacing the ordinary methods (direct inoculation on plates).