Yuksel SECKİN, Yasir Furkan CAGİN, Fatma SENER

Assitdeki myeloperoksidaz düzeyi spontan bakteriyel peritonit için prediktif bir faktör müdür?

Amaç: Myeloperoksidaz başlıca insan polimorfnükleer nötrofillerin azurofilik granüllerinde yer alıp, konakçı savunmasında rol alan enzimlerinden biridir. Sirozlu hastalarda hem humoral ve hem de hücresel immünitedeki bozukluk, karaciğer filtrasyon fonksiyonundaki azalma ve assit sıvısının antimikrobiyal kapasitesinin azalması spontan bakteriyel peritonit riskini artırmaktır. Bu çalışmanın amacı spontan bakteriyel peritonitin sık görüldüğü karaciğer sirozu ve karaciğer sirozu dışı hastalıklara bağlı assit gelişen bireylerdeki serum-assit myeloperoksidaz düzeyi arasında bir fark olup olmadığını araştırmaktır. Gereç ve Yöntemler: Çalışmaya karaciğer sirozu ve karaciğer sirozu dışı hastalıklara bağlı 28' i erkek ve 23'ü kadın toplam 51 assitli birey ve 8'i erkek, 8'i kadın toplam 16 sağlıklı birey olmak üzere üç grup dahil edildi. Serum-assit albümin gradiyenti hesaplandı, kan ve assit sıvısında myeloperoxidaz ve beyaz küre bakıldı. Bulgular: Karaciğer sirozu ve karaciğer sirozu dışı nedenlerden gelişen assitli bireylerin serumassit albümin gradiyentleri, kan beyaz küre sayısı yönünde istatistiksel olarak anlamlı bir ilişki bulunamadı. Karaciğer sirozu ve karaciğer siroz dışı nedenlerden dolayı gelişen assitli bireyler ve kontrol grubu bireylerin serum myeloperoksidaz düzeyleri, yaş ve cinsiyet yönünde de anlamlı bir ilişki bulunamadı. Karaciğer sirozuna bağlı gelişen assitdeki myeloperoksidaz düzeyi, karaciğer sirozu dışı nedeniyle oluşan assitteki myeloperoksidaz düzeyinden anlamlı daha düşük bulundu. Sonuç: Sonuç olarak myeloperoksidazın immün sistemde önemli bir rolü olması nedeniyle, myeloperoksidaz düşüklüğünün karaciğer sirozunda spontan bakteriyel peritonitinin artışının bir nedeni olabileceğini düşündük.

Is myeloperoxidase level in ascites a predictive factor for spontaneous bacterial peritonitis?

Aim: Myeloperoxidase is mainly found in the azurophilic granules of human polymorphic nucleated neutrophils, and it is one of the enzymes that has a role in the host defense. Deteriorations in both humoral and cellular immunity, and decreases in the filtration functions of liver and the antimicrobial capacity of ascites fluid increase the risk of spontaneous bacterial peritonitis in patients with cirrhosis. The aim of this study is to evaluate if there is a difference in the serum-ascites myeloperoxidase levels of patients with ascites due to liver cirrhosis and other non-cirrhotic diseases, which are clinical conditions that spontaneous bacterial peritonitis is frequently seen. Materials and Methods: This study included a total of 51 patients (28 males and 23 females) with ascites due to liver cirrhosis and non-cirrhotic diseases, and 16 healthy subjects (8 males and 8 females). Serum-ascites albumin gradient was calculated, and myeloperoxidase and leukocyte count were determined in both blood and ascites fluid. Results: Serum-ascites albumin gradient, and blood leukocyte count were statistically similar between patients with ascites due to liver cirrhosis and non-cirrhotic diseases. There was no significant difference between serum myeloperoxidase levels, age and sex of patients with cirrhosis due to liver cirrhosis and non-cirrhotic diseases, and control group subjects. Myeloperoxidase levels in ascites of patients with liver cirrhosis were significantly lower than patients with non-cirrhotic diseases. Conclusion: Since myeloperoxidase has an important role in immune system, we concluded that decreases in myeloperoxidase might have a role in increased spontaneous bacterial peritonitis in liver cirrhosis.

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