[Diagnostic value of human neutrophil peptide in spontaneous bacterial peritonitis].

OBJECTIVE: To investigate the correlation between human neutrophil peptide (HNP) and spontaneous bacterial peritonitis (SBP) in order to assess the diagnostic value of quantitative measurement of these alpha-defensins. METHODS: Seventy-seven patients with cirrhosis and ascites were divided into two groups according to diagnosis of SBP (n = 45 with SBP and n = 32 without SBP). Twenty-eight healthy individuals were analyzed as controls. HNP was detected by double-antibody sandwich assay. Peripheral white blood cell (WBC) counts, neutrophil ratio, and levels of procalcitonin (PCT) and C-reactive protein (CRP) were determined by standard methods. Receiver operating characteristic (ROC) curves were used to compare the diagnostic values of HNP, PCT and CRP in SBP. RESULTS: There were no significant differences between the three groups (SBP, non-SBP, and healthy controls) for WBC count ((6.01+/-2.25)*109 /L, (4.85+/-1.94)*109 /L, and (5.49+/-1.76)*109 /L; F = 2.91, P more than 0.05) and neutrophil ratio (70.70%+/-10.42%, (68.20%+/-8.97%, and 69.50%+/-8.69%; F = 3.07, P more than 0.05). However, compared to the non-SBP group and the healthy controls, the SBP group showed significantly higher levels of HNP ((9.99+/-3.33) ng/ml and (8.92+/-2.30) ng/ml vs. (17.66+/-6.40) ng/ml; q = 3.20 vs. 3.52, P less than 0.05), serum CRP ((15.08+/-9.95) ng/ml and (5.96+/-2.91) ng/ml vs. (31.32+/-18.65) mg/L; q = 11.03 vs. 3.69, P less than 0.05), and positive rate of PCT (25.0% and 10.0% vs. 62.2%; X2 = 10.41 vs. 15.40, P less than 0.0125). The areas under the curve (AUC) showed the following descending trend: HNP more than PCT more than CRP (0.719, 0.707, and 0.629 respectively). Using cut-off points of 10 ng/ml for HNP, 0.5 ng/ml for PCT, and 8 mg/L for CRP, the respective sensitivities for diagnosis of SBP were 71.1%, 62.2%, and 73.3%, the respective specificities were 71.9%, 75.0%, and 56.3%, and the respective Youden's indexes were 0.430, 0.372, and 0.296. CONCLUSION: HNP is closely related to SBP and can diagnose SBP as reliably as PCT. CRP may help to diagnose SBP, but the results from routine blood testing did not show sufficient statistical significance for diagnosing SBP.

[Clinical implication of expression of perforin/granzyme in peripheral blood lymphocyte in severe hepatitis B].

OBJECTIVE: To explore role of perforin/granzyme expression of peripheral blood lymphocyte in injury of hepatocyte in severe hepatitis B, and evaluate relationship between perforin/granzyme expression levels and hepatitis B virus (HBV)-DNA load. METHODS: Thirty eight patients of severe hepatitis B were enrolled in the study. Fasting venous blood was collected on following morning of admission. Twenty adult healthy subjects served as healthy control group. Perforin/granzyme expression of peripheral blood lymphocyte was detected by flow cytometry, and serum HBV-DNA load was detected by fluorescence quantitative polymerase chain reaction (PCR). RESULTS: Positive rate of perforin/granzyme in peripheral blood lymphocyte in severe hepatitis B was higher than that of the healthy control group [perforin: (43.42+/-19.28)% vs. (19.65+/-9.27)%, granzyme: (40.35+/-12.26)% vs. (22.28+/-9.35)%, both P<0.01]. There was a significant negative correlation between the perforin/granzyme expression of peripheral blood lymphocyte and serum HBV-DNA load (r(perforin) =-0.92, r(granzyme) =-0.96, both P<0.01), the higher serum HBV-DNA load, the lower perforin/granzyme expression in severe hepatitis B. CONCLUSION: Perforin/granzyme overexpression in peripheral blood lymphocyte is an important factor in injury of hepatocyte in patients with severe hepatitis B, and the expression may be involved in HBV-DNA cleanup.

[Antiviral therapy of chronic hepatitis B patients resistant to lamivudine].

BACKGROUND: To evaluate the efficacy of alpha-2b interferon alone or combined with alpha1-thymosin in treatment of patients with chronic hepatitis B (CHB) resistant to lamivudine. METHODS: Sixty six patients with CHB resistant to lamivudine were enrolled and randomized into treatment group A, treatment group B and control group. In the treatment group A 26 cases, after giving interferon-alpha alone for 1 month, lamivudine was withdrawn and continuously treated with interferon-alpha for 5 months. In the treatment group B 10 cases, after treatment with interferon-alpha and thymosin-alpha1 for 1 month, lamivudine was withdrawn and continuously treated with interferon-alpha and thymosin-alpha1 for 5 months. In control group (30 cases), after lamivudine was directly withdrawn, no anti-virus drug was given. Hepatic function tests and serum virological index were detected at regular intervals in all patients. RESULTS: Normalization rate of hepatic function, HBV DNA seroconversion rate and HBeAg/HBeAb seroconversion rate in two treatment groups were significantly higher than those in control group. CONCLUSION: The study suggested that interferon-alpha alone or combined with thymosin-alpha1 in treatment of patients with chronic hepatitis B resistant to lamivudine showed a beneficial effect.