الفهرس 
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Abstract
SBP is a very common bacterial infection in patients with cirrhosis and ascites. The diagnosis of SBP is made in the presence of an elevated ascitic fluid absolute polymorphonuclear leukocyte (PMN) count ≥250 cells/ mm3 without an evident intra-abdominal, surgically treatable source of infection.
The greatest sensitivity for the diagnosis of SBP is reached with a cutoff neutrophil count of 250/ mm3, although the greatest specificity is reached with a cutoff of 500 neutrophils/ mm3. The gold standard for ascitic neutrophil count is manual microscopy, but it is associated with interobserver variability, time and costs.
Despite the use of sensitive methods, ascitic fluid culture is negative in as many as 60% of patients with clinical manifestations suggestive of SBP and increased ascites neutrophil count. It is not necessary for diagnosis of SBP but it is important to guide antibiotic therapy.
Peritoneal infection causes an inflammatory reaction resulting in an increased number of neutrophils in ascitic fluid. One of the candidate markers for diagnosis of SBP is calprotectin level, whether in serum or in ascitic fluid.
Calprotectin is a 36-kDa calcium and zinc binding protein, which for practical purposes can be considered to be neutrophil-specific, although low levels are found in other phagocytic cells. Calprotectin accounts for approximately 60% of total soluble proteins in the cytosol fraction of neutrophils.
The present study was held to to evaluate the role of serum and ascitic fluid calprotectin as surrogate markers for spontaneous bacterial peritonitis in cirrhotic patients.
The study was conducted on 50 subjects in Alexandria Main University Hospital, Tropical Medicine Department. The subjects were divided into three groups. group I consisted of 10 patients with liver cirrhosis without ascites; group II included 20 patients with ascites without SBP; group III consisted of 20 patients with SBP.
Pateints with inflammatory bowel disease, colorectal cancer, hepatocellular carcinoma, malignant ascites, HIV, rheumatoid arthritis, multiple sclerosis and cystic fibrosis were excluded from the study.
All patients and controls were subjected to the following:
1. Detailed history and thorough clinical examination.
2. Laboratory investigations including:
a. Routine investigations :
i. Complete blood picture, ESR and CRP
ii. Renal function tests and serum electrolytes
iii. Fasting blood glucose level
b. Liver function tests and liver enzymes including serum alanine transaminase (ALT), serum aspartate transaminase (AST), serum albumin, serum bilirubin, prothrombin time, INR and alkaline phosphatase (ALP)
c. Viral markers ( Anti-HCV, HBs Ag , HIV Abs)
d. Alpha fetoprotein, CEA and CA19.9
3. Ascitic fluid Chemistry (Protein, glucose, LDH) and cytology (WBCs, neutrophils, lymphocytes, RBCs) as well as culture and sensitivity.
4. Serum Calprotectin and Ascitic fluid Calprotectin measurement by ELISA kits named Human calprotectin (CALPRO) ELISA kit.
5. Abdominal ultrasonography and Triphasic CT of the abdomen if required
Statistical analysis of data obtained from the present study revealed the following results:
• As regards age and sex, there were no statistically significant differences between the three groups.
• Regarding symptoms, the most frequent complains in the three groups were abdominal pain followed by easy fatigability.
• Regarding signs, the most frequent sign in group I was splenomegaly, while ascites was the most frequent sign in group II and group III.
• As regards haematological findings, there were statistically significant differences between group I and group III and there was statistically significant differences between group II and group III regarding WBCs. Otherwise, there was no statistically significant differences between the three groups.
• As regards liver enzymes, there was no statistically significant difference between the three groups regarding ALT, AST, while ALP were significantly higher in groups III than in group II.
• Liver function tests showed significantly higher serum bilirubin, higher INR and more prolonged prothrombin time in the SBP group than in groups I and III. While albumin level was lower in the ascitic groups than in group I.
• Regarding renal functions, blood urea and serum creatinine were significantly higher in the SBP group than in groups I and II.