Low protein concentration in cirrhotic ascites is related to low ascitic concentrations of immunoglobulins G and A.
OBJECTIVE
To analyse the differences in ascitic and serum levels of immunoglobulins and albumin between two groups of cirrhotic patients (with ascitic total protein levels higher and lower than 10 g/l).


METHODS
A prospective study.


METHODS
We studied 39 cirrhotic patients with sterile ascites. The patients were classified into two groups: group A (18 patients) comprised those with an ascitic total protein level less than 10 g/l and group B (21 patients) those with an ascitic total protein level higher than 10 g/l. Ascitic and serum levels of albumin and immunoglobins G, A and M were analysed.


RESULTS
Ascitic immunoglobulin G and A levels in group B were higher than ascitic immunoglobulin G and A levels in group A. Ascitic levels of these immunoglobulins correlated linearly with ascitic total protein levels. The serum levels of immunoglobulins G and A in groups A and B were not significantly different. Ascitic and serum immunoglobulin M concentrations in the two groups were similar. Transfer of immunoglobulins G and A and albumin from plasma to ascites seemed to be similar in group B. Transfer of immunoglobulins G and A seemed to be impaired in group A. Differences in ascitic immunoglobulin levels between groups A and B were also observed in the presence of diuretic treatment. Differences in ascitic immunoglobulin levels were related to the Child-Pugh score.


CONCLUSIONS
Patients with a low ascitic total protein level show low ascitic immunoglobulin G and A concentrations. The low ascitic immunoglobulin G and A levels could be related to an impairment in the transfer of these immunoglobulins from plasma in those patients who have poor liver function. Ascitic immunoglobulin M is not related to ascitic total protein, and its origin is not clear. The putative transfer of immunoglobulin M to the peritoneal cavity is not related to the mechanism of transfer of albumin or of immunoglobulins G and A from serum. The physiological significance of ascitic immunoglobulin M is unclear.
García-Díaz
M
M
Gastroenterology Unit, Infanta Cristina University Hospital, University of Extremadura, Badajoz, Spain.
Alcalde
M
M
de Sande
F
F
Romero
J
J
Sánchez-Risco
P
P
Pijierro
A
A
Pascasio
J M
JM
Soria
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000175:diagnosis / Q000276:immunology*; D001424:Bacterial Infections / Q000175:diagnosis / Q000276:immunology; D001798:Blood Proteins / Q000378:metabolism; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D007074:Immunoglobulin G / Q000097:blood*; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000276:immunology*; D008297:Male; D010538:Peritonitis / Q000175:diagnosis / Q000276:immunology; D012016:Reference Values; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism*
D001798:Blood Proteins; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D012709:Serum Albumin