title: Lymphocyte subsets and cytokines in ascitic fluid of decompensated cirrhotic patients with and without spontaneous ascites infection.
abstract: OBJECTIVE
  Spontaneous ascites infection is a frequently encountered and important complication of decompensated liver cirrhosis. The immune system plays an important role in the development or eradication of this infection. A number of compositional and functional alterations in immune system cells have been demonstrated in cirrhotic patients; however, there is a lack of knowledge about this issue in ascitic infections. The aim of the present study was to evaluate lymphocyte subsets and levels of some ascitic and lymphocytic intracytoplasmic cytokines in decompensated cirrhotic patients with or without spontaneous ascites infection.
  
  
  METHODS
  The study population consisted of 45 decompensated cirrhotic patients (32 men, 13 women) with different etiologies. Patients with ascitic polymorphonuclear leukocyte count > or =250/mm(3) and/or positive ascitic bacterial cultures were classified as the "infected group". Comparison was made between the infected and non-infected group for the following parameters: ascites leukocyte counts and differentiations; ascitic fluid protein; albumin levels and serum-ascites albumin gradients; flow cytometric detection of cell surface markers for ascitic T, B and natural killer lymphocytes; intracytoplasmic interleukin (IL)-2, IL-4, tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma; levels of ascitic IL-8, IL-10, IL-12 and TNF-alpha; and soluble Fas antigen and soluble Fas ligand.
  
  
  RESULTS
  The CD4/CD8 ratio was significantly decreased and expression of T cell receptor-gammadelta was increased in the infected group. Furthermore, ascites TNF-alpha levels were also elevated in this group. Ascitic IL-8, IL-10, IL-12 and TNF-alpha levels were significantly higher in patients with positive ascitic bacterial culture.
  
  
  CONCLUSIONS
  These results suggest that a cytotoxic, especially Th1, immune response predominates in ascites infections. It also demonstrates that TNF-alpha might be involved in the pathogenesis of ascites infections.
authors.affiliation: Department of Gastroenterology, Medical Faculty, Uludag University, Bursa 16059, Turkey. mkiyici@uludag.edu.tr
authors.forename: Murat
authors.initials: M
authors.lastname: Kiyici
authors.forename: Selim Giray
authors.initials: SG
authors.lastname: Nak
authors.forename: Ferah
authors.initials: F
authors.lastname: Budak
authors.forename: Selim
authors.initials: S
authors.lastname: Gurel
authors.forename: Barbaros
authors.initials: B
authors.lastname: Oral
authors.forename: Enver
authors.initials: E
authors.lastname: Dolar
authors.forename: Macit
authors.initials: M
authors.lastname: Gulten
mesh_terms: D001201:Ascites / Q000276:immunology* / Q000382:microbiology*; D001202:Ascitic Fluid / Q000737:chemistry / Q000276:immunology / Q000382:microbiology; D001424:Bacterial Infections / Q000150:complications / Q000276:immunology*; D016516:CD4-CD8 Ratio; D016207:Cytokines / Q000032:analysis*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000276:immunology*; D016131:Lymphocyte Subsets / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D016692:Receptors, Antigen, T-Cell, gamma-delta / Q000032:analysis; D018417:Th1 Cells / Q000276:immunology
chemical_list: D016207:Cytokines; D016692:Receptors, Antigen, T-Cell, gamma-delta