Disorders of Liver : Increased Intestinal Macromolecular Permeability And Urine Nitrite Excretion Associate With The Liver Cirrhosis With Ascites = Disorders of Liver : Increased Intestinal Macromolecular Permeability And Urine Nitrite Excretion Associate With The Liver Cirrhosis With Ascites

다국어 초록 (Multilingual Abstract)

Background/Aims: Increased intestinal permeability, endotoxemia with tumor necrosis factor (TNF)-α and nitric oxide (NO) have been implicated as contributory factors in the development of encephalopathy and bacterial infections in chronic liver diseases. The aim of this study was to determine whether intestinal permeability, serum TNF-α level and NO metabolite in urine are altered in liver cirrhosis (LC) with or without ascite. Methods: Fifty three patients with LC and 26 healthy control subjects were studied. The intestinal permeability value is expressed as the percentage of polyethylene glycol (PEG) 400 and 3350 retrieval in 8-hr urine samples by high performance liquid chromatography. Serum TNF-α concentration was determined by the ELISA. NO metabolite, nitrite in urine was assayed by Greiss reaction method. Results: The causes of liver cirrhosis were alcohol (n=31), virus (HBV 14, HCV 7)(n=21) and alcohol combined with HBV(n=1). Mean values for PEG 400 and 3350 retrieval were 46.5±3.22 and 0.24±0.03 in controls, 44.1±5.17 and 0.21±0.02 in LC without ascite and 37.4±3.55 and 0.31±0.04 in LC with ascite respectively. Intestinal permeability index was significantly higher in LC with ascite than healthy controls or LC without ascite (0.88±0.12 vs. 0.52±0.05 or 0.53±0.03, p＜0.05) and correlated with urine nitrite excretion. Interestingly, serum TNF-α concentration was significantly higher in LC without ascite than in controls or LC with ascite (198.9±55.8 pg/mL vs. 40.9±12.3 pg/mL or 32.1±13.3 pg/mL, P<0.05). Urine nitrite excretion was significantly higher in LC with ascite than in controls or LC without ascite (1,170.9±28.7 umol/L vs. 903.1±55.1 umol/L or 956.7±47.7 umol/L, p<0.05). Conclusions: The current study suggested that increased intestinal macromolecular permeability and NO are probably of importance in the pathophysiology and progression of liver cirrhosis with ascite, but serum TNF-α concentration was not related with LC with ascite.