LOW-PROTEIN CONCENTRATION IN CIRRHOTIC ASCITES IS RELATED TO LOW ASCITIC CONCENTRATIONS OF IMMUNOGLOBULIN-G AND IMMUNOGLOBULIN-A

Objective: To analyse the differences in ascitic and serum levels of i mmunoglobulins and albumin between two groups of cirrhotic patients (w ith ascitic total protein levels higher and lower than 10 g/l). Design : A prospective study. Patients and methods: We studied 39 cirrhotic p atients with sterile ascites. The patients were classified into two gr oups: group A (18 patients) comprised those with an ascitic total prot ein level less than 10g/l and group B (21 patients) those with an asci tic total protein level higher than 10g/l. Ascitic and serum levels of albumin and immunoglobins G, A and M were analysed. Results: Ascitic immunoglobulin G and A levels in group B were higher than ascitic immu noglobulin G and A levels in group A. Ascitic levels of these immunogl obulins correlated linearly with ascitic total protein levels. The ser um levels of immunoglobulins G and A in groups A and B were not signif icantly different. Ascitic and serum immunoglobulin M concentrations i n the two groups were similar. Transfer of immunoglobulins G and A and albumin from plasma to ascites seemed to be similar in group B. Trans fer of immunoglobulins G and A seemed to be impaired in group A. Diffe rences in ascitic immunoglobulin levels between groups A and B were al so observed in the presence of diuretic treatment. Differences in asci tic immunoglobulin levels were related to the Chiid-Pugh score.Conclus ion: Patients with a low ascitic total protein level show low ascitic immunoglobulin G and A concentrations. The low ascitic immunoglobulin G and A levels could be related to an impairment in the transfer of th ese immunoglobulins from plasma in those patients who have poor liver function. Ascitic immunoglobulin M is not related to ascitic total pro tein, and its origin is not clear. The putative transfer of immunoglob ulin M to the peritoneal cavity is not related to the mechanism of tra nsfer of albumin or of immunoglobulins G and A from serum. The physiol ogical significance of ascitic immunoglobulin M is unclear.