Patients with Spontaneous Bacterial Peritonitis
C-reactive protein (CRP) is an acute phase 6-globulin. While the precise in vivo functions of CRP during the inflammation state is not known, there is considerable evidence indicating a role in the recognition and elimination of foreign pathogens as well as potentially toxic endogenous substances released from damaged tissue by assisting humoral and cellular immunity. CRP, as a acute phase reactant, binds to different substrates. It activates the complement system, takes part in cytokine secretion and increases the phagocytosis of leukocytes.
Cytokines, also known as peptide-regulating molecules, are released from the damaged tissues and induce CRP formation and secretion from hepa-tocytes. Tumor necrosis factor alpha (TNF-a) increases the synthesis of acute phase proteins from hepatocytes. CRP and cytokines have also a self-induction mechanism. In a number of studies performed on human monocyte cultures, TNF-a was shown to have increased in CRP-rich medium. Different cells are shown to produce TNF-a; for example, macrophages, CD+ T cells and natural killer cells after stimulation with lipopolysaccharides. Additionally, smooth muscle cells, polymorphonuclear neutrophils, astrocytes and a variety of tumor cells lines can produce TNF-a. tamsulosin 0.4 mg
TNF-a acts via two distinct cell surface receptors, which are called TNF receptor (TNF-r) I (p55) and TNF-r II (p75). These receptors can be identified on virtually all cell types except erythrocytes. The biological effects of TNF-a and TNF-r can be subgrouped into four categories: metabolic antitu-moral, immunity and inflammation, hematopoiesis, and differentiation. The receptor number increases proportionally in response to plasma TNF-a levels. Besides the cell-bound forms of the TNF-r, soluble forms are known which are capable of TNF-a binding. Therefore, they compete with the cell-bound forms and can inhibit the effects of TNF-a. Due to the occurrence of TNF-a receptors on nearly all cells, TNF-a shows a wide variety of biological actions. It has cytolytic and cytostatic effects on tumor cells and shows chemotactic activity on neutrophils. TNF-oc serum or plasma levels may be elevated in sepsis, autoimmune diseases, various infectious diseases and transplant rejection. In this study, we determined serum and ascitic fluid CRP, TNF-oc and TNF-r levels in patients with spontaneous bacterial peritonitis (SBP), and malignant and cirrhotic ascites. buy finasteride online