title: Low protein concentration in cirrhotic ascites is related to low ascitic concentrations of immunoglobulins G and A.
abstract: 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.
authors.affiliation: Gastroenterology Unit, Infanta Cristina University Hospital, University of Extremadura, Badajoz, Spain.
authors.forename: M
authors.initials: M
authors.lastname: García-Díaz
authors.forename: M
authors.initials: M
authors.lastname: Alcalde
authors.forename: F
authors.initials: F
authors.lastname: de Sande
authors.forename: J
authors.initials: J
authors.lastname: Romero
authors.forename: P
authors.initials: P
authors.lastname: Sánchez-Risco
authors.forename: A
authors.initials: A
authors.lastname: Pijierro
authors.forename: J M
authors.initials: JM
authors.lastname: Pascasio
authors.forename: A
authors.initials: A
authors.lastname: Soria
mesh_terms: 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*
chemical_list: D001798:Blood Proteins; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D012709:Serum Albumin