Opsonic activity of ascitic fluid is an important defensive mechanism against spontaneous bacterial peritonitis (SUP). It is determined by many factors including its coentent of complement 3 (CO. Recently. diuresis has been shown to increase ascitic fluid opsonic activity. This randomized controlled study was performed to compare the effects of different approaches of managing hepatic ascites -namely, diuretics, repeated large volume paracentesis (LVP) and single (LVP) followed by diuretics- on ascitic C3. Thirty patients with cirrhotic ascites were allocated randomly into 3 groups: group 1 included 10 patients treated with diuretics alone. groups 2 included 10 patients treated with repeated large volume paracentesis (LVP) and group 3 included 1() patients treated with initial single (LVP) followed by diuretics. The ascitic fluid of all patients were tested for opsonic activity and C3 concentration at :the beginning and at the end of treatment. The diuretic group showed a highly significant increase in both opsonic activity (P < 0.0002) - and C3 (P < 0.0003). A similar but less significant changes were noticed-in patients treated with LVP then dinretics where a significant increase in both opsonit activity (P < 0.005) and C; (Pc 0.02) were reported. In contrast paracentesis group Maintained stable opsonic activity and C; leYel without significant changes. A significant positive correlation was noticed between ascetic C; level and its opsonic activity (P < 0.01. r = 0.45). This study suggests that diuretic therapy for cirrhotic ascites may have the potential advantage over paracentesis of providing better protection from spontaneous bacterial peritonitis (SBP) through increasing ascitic opsonic activity and C; concentration. Study of larger numbers of patients will determine if these changes in C3 and opsonic activity translate into an increased or decreased risk of SBP in vivo |
