儿童及成年急性穿孔性阑尾炎患者细胞因子变化与临床意义

Change of cytokines content in acute perforated appendicitis patients

目的:探讨儿童及成年急性穿孔性阑尾炎(APA)患者血清细胞因子(CKs),即肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)及白介素-8(IL-8)的含量变化,为临床诊治提供思路及依据。方法:25例APA患儿及20例成年患者术后即刻采集血液标本,检测以上3项CKs及白细胞计数(WBC)、C-反应蛋白(CRP)水平,并测取同期来院查体的健康儿童及成年人各15例的标本作为参考值。观察记录患者(儿)的临床指标,并将以上5项指标与临床指标进行相关性分析。结果:(1)所有患者(儿)术后即刻的WBC、CRP、TNF-α、IL-6及IL-8水平均明显高于参考值(P<0.05),治疗后均明显呈不同程度回落;尽管出院前患儿组的WBC、CRP已恢复正常,但TNF-α、IL-6及IL-8仍高于参考值,且高于成年患者(P<0.05);(2)术后患儿组的腹痛、腹胀的消退时间,体温、肠蠕动的恢复时间及住院时间均较成年患者长(P均<0.05);(3)相关性分析显示TNF-α、IL-6、IL-8、WBC及CRP5项指标两两间呈较强的正相关性(均为r>0.80,P<0.01);术后即刻TNF-α、IL-6及IL-8的水平与住院时间均呈负相关性(分别为r=-0.67,-0.78,-0.72;P=0.035,0.029,0.032)。结论:(1)TNF-α、IL-6及IL-8三者适用于评价APA的炎症程度,且与患者(儿)的预后有关;(2)儿童APA的CKs含量高于成年患者,可能与儿童的免疫力低下有关;(3)WBC与CRP不能作为儿童APA痊愈出院的单一标准,应适当检测CKs以协助临床决策。

Objective：To discuss the content changes of serum cytokines（CKs）,or tumor necrosis factor-α（TNF-α）,interleukin-6（IL-6）and interleukin-8（IL-8）in both children and adults with acute perforated appendicitis（APA）.Methods：Blood samples were collected from 25 children and 20 adults with APA immediately after operation for detection of TNF-α,IL-6,IL-8,white blood cell count（WBC）and C-reactive protein（CRP）levels.At the same time,samples collected from 15 healthy children and 15 adults were also collected as a reference.Besides,clinical indicators of all studied patients were under observation and correlation among the above mentioned 5 parameters were analyzed.Results：（1）WBC,CRP,TNF-α,IL-6 and IL-8 levels in all patients were significantly higher than the reference value（P〈0.05）,while after treatment they all dropped at certain degree.Although WBC and CRP dropped back to normal levels in all children,TNF-α,IL-6 and IL-8 levels were still higher than the reference value and levels in their counterpart adult patients（P〈0.05）.（2）Time length of abdominal pain,abdominal distension,increased temperature,abnormal bowel movement and hospital stay for children were all longer than adult patients（P all 〈0.05）;（3）TNF-α,IL-6,IL-8,WBC and CRP were all strong positive correlated with each other（all r〉 0.80,P〈0.01）;TNF-α,IL-6 and IL-8 levels and length of hospital stay were negative correlated（respectively,r=-0.67,-0.78,-0.72;P= 0.035,0.029,0.032）.Conclusions：（1）TNF-α,IL-6 and IL-8 levels can be used for assessment of the APA severity,and the prognosis of children patients.（2）CKs level was higher in children patients than adults,which is probably related to the poor immunity of their physical characters.（3）WBC and CRP can not be used alone as the sign of discharge for children patients,CKs level detection should be also detected and took into consideration.