白细胞介素6及其基因启动子多态性在儿童急性阑尾炎中的表现

Interleukin-6 and its gene promoter polymorphisms in children with acute appendicitis

目的①研究血清、腹腔渗液中白细胞介素6(interleukin-6,IL-6)的水平在小儿急性阑尾炎诊断及严重程度分型中的价值;②探讨IL-6基因启动子-174G/C、-572G/C位点的多态性与小儿急性阑尾炎严重程度的关系。方法选取101例急性阑尾炎患儿,依据病理诊断分为普通组(单纯/化脓)、重症组(坏疽/穿孔)两组,以健康儿童为对照,ELISA法检测血清及腹腔渗液中IL-6浓度,用PCR-RFLP并测序法确定IL-6基因启动子的基因型。应用SPSS10.0统计软件对原始数据进行统计学处理。结果①普通组及重症组血IL-6浓度均明显高于对照组,P<0.01;重症组血IL-6浓度明显高于普通组P<0.01;重症组腹腔渗液IL-6、血C反应蛋白的浓度明显高于普通组,发病时间明显长于普通组,P<0.01。②重症组-572CC型频率明显高于普通组,P=0.011;三组间-174位点基因型频率的差异无显著性意义。③重症组及对照组-572CC型患儿血清IL-6表达水平明显高于-572G携带型,P<0.05;普通组-572CC型血清IL-6的表达水平高于-572G携带者,P=0.056。④logistic regression多因素分析结果表明-572位点的基因型、发病时间(症状出现至手术)与重症阑尾炎的发生有关。结论①IL-6有助于小儿急性阑尾炎的诊断及严重程度分型。但非急性阑尾炎或急性重症阑尾炎的特异性检测指标;②IL-6基因启动子-572位点CC型与小儿重症阑尾炎发生有关,IL-6基因-572C等位基因调控转录及表达的具体机制尚需进一步研究。

Objective To evaluate interleukin-6 （IL-6） level and its gene promoter polymorphisms in different pathological types of acute appendicitis in children. Methods We recruited 101 children with acute appendicitis and a control group from healthy, children. The patients were divided into two groups based on pathological diagnosis： complicated group with gangrene or perforation of the appendix, and uncomplicated group with other pathological types. The concentrations of IL-6 in plasma and peritoneal fluid were determined by ELISA. And IL-6 gene promoter polymorphisms （ - 174G/C and - 572G/C） were genotyped by PCR-RFLP and auto-sequencing. Results Plasma concentration of IL-6 in patients, either in complicated group or in uncomplicated group, was significantly higher than that in control group. Concentrations of IL-6 in plasma and peritoneal fluid in complicated group were significantly higher than those in uncomplicated group. Moreover, the frequency of - 572CC genotype in complicated group （83. 3% ） was significantly higher than that in uncomplicated group （58. 5%）. There were no significant differences among the patient groups or between patient and control group in the frequency of polymorphisms of IL-6 gene promoter - 174G/C. In complicated group and in control group, plasma concentrations of IL-6 in genotyping - 572CC was significantly higher than that of - 572G carriers （P〈0. 05）. And the logistic regression analysis showed that the complicated appendicitis was associated with IL-6 gene promoter - 572 polymorphisms. Conclusions The complicated acute appendicitis was associated with IL-6 gene promoter- 572 CC genotype. And detecting plasma IL-6 is helpful in differentiating complicated acute appendicitis from uncomplicated ones in children.