腔镜及开腹阑尾切除术对阑尾穿孔腹膜炎脓毒症患儿血清IL-6、TNF-α及IL-10的影响

Effects of serum levels of interleukin-6, tumor necrosis factor alpha and interleukin-10 between laparoscopic and open appendectomy in children with peritonitis and sepsis secondary to appendicitis perforation

目的探讨腹腔镜（LA）及开腹（OA）手术对阑尾穿孔、脓毒症患儿血清白细胞介素6（IL-6）、肿瘤坏死因子-α（TNF-α）及白细胞介素10（IL-10）的影响。方法采用双抗体夹心ELISA法测定腹腔镜手术组（LA组）36例及开腹手术组（OA组）31例OA患儿术前及术后不同时间点血清中IL-6、TNF-α及IL-10的含量，比较血清中IL-6、TNF-α及IL-10水平在LA组及OA组的差异。结果LA组术前血清IL-6、TNF-α及IL-10水平为（148．3±19．0）pg／ml、（81．4±10．7）pg／ml、（156．9±39．5）pg／ml，术后第1、3、7天血清IL6水平为（172．7±23．2）pg／ml、（80．1±11．3）pg／ml、（23．9±4．9）pg／ml，TNF-α水平为（97．3±12．7）pg／ml、（52．4±9．3）pg／ml、（23．7±6．8）pg／ml，IL-10水平为（215．3±57．9）pg／ml、（145．3±32．6）pg／ml、（47．8±8．4）pg／ml；OA组术前血清IL-6、TNF-α及IL-10水平为（144．2±22．1）pg／ml、（80．5±8．9）pg／ml、（156．8±42．3）pg／ml，术后第1、3、7天血清IL-6水平为（184．5±26．8）pg／ml、（135．3±19．2）pg／ml、（65．2±16．4）pg／ml，TNF-α水平为（102．8±11．4）pg／ml、（84．5±11．7）pg／ml、（48．3±9．5）pg／ml，IL-10水平为（179．1±48．9）pg／ml、（114．4±26．7）pg／ml、（52．7±12．3）pg／ml。术前两组患儿血清IL-6、TNF-α及IL-10水平差异无统计学意义（P〉0．05）；LA组术后第1、3、7天血清IL-6、TNF-α水平均较OA组低且差异有统计学意义（P〈0．05）；LA组术后第1、3天血清IL-10水平均较0A组高且差异有统计学意义（P〈0．05），术后第7天LA组较OA组低，但两者比较差异无统计学意义（P〉0．05）；LA组与0A组比较，血清IL-6、TNF-α水平术后升高缓慢，幅度小，下降迅速，血清IL-10水平升高迅速，幅度大，下降迅速。结论LA可减少阑尾穿孔腹膜炎、脓毒症患儿血清中炎性因子IL-6及TNF-α水平，增加血清中抗炎性因子IL-10水平，LA能减轻机体的应激反应、炎性反应，增强机体抗炎反应。

Objective To evaluate the effects of taparoscopic appendectomy （LA） and open appendectomy （OA） on serum levels of pro-inflammatory cytokine interleukin-6 （IL-6）, tumor necrosis factor alpha （TNF-α） and anti-inflammatory cytokine interleukin-10 （IL-10） in children with peritonitis and sepsis secondary to appendicitis perforation. Methods A total of 67 patients were recruited to undergo either LA （n = 36） or OA （n = 31）. The serum levels of IL-6, TNF-α and IL-10 were measured with enzyme-linked immunosorbent assay （ELISA） at preoperation and different timepoints postoperation. And the differences of serum levels of IL-6, TNF-α and IL-10 in laparoscopic group and open group. Results In the LA group, the pre-operative and post-operative Day 1, 3 and 7 serum levels of IL-6, TNF-α and IL-10 were （148. 3 ± 19. 0）, （81.4 ± 10. 7） ＆ （156. 9 ±39.5） pg/ml, （172.7±23.2）, （80.1±11.3） ＆ （23.9±4.9）pg/ml, （97.3±12.7）, （52.4± 9. 3） ＆ （23.7 ± 6. 8） pg/ml and （215.3 ± 57. 9）, （145.3 ± 32. 6） ＆ （47. 8 ± 8. 4） pg/ml; For the OA group, （144. 2 ± 22. 1）, （80. 5 ± 8.9） ＆ （156. 8 ± 42. 3） pg/ml, （184. 5 ± 26. 8）, （135.3 ± 19. 2） （65.2±16.4） pg/ml, （102.8±11.4）, （84.5±11.7） ＆ （48.3±9.5） pg/ml and （179. 1± 48. 9）,（114. 4 ± 26. 7） ＆ （52. 7 ± 12. 3） pg/ml respectively. Their preoperative levels were not different between two groups （P〈0. 05）. The serum levels of IL-6 and TNF-α at Day 1, 3 and 7 post-operation in the laparoscopic group were lower than those in the open group （P〈0. 05）. The serum levels of IL- 10 at Day 1 and 3 post-operation in the laparoscopic group were higher than those in the open group （P 〈0. 05）. At Day 7, the serum levels of IL-10 in the laparoscopic group were lower than those in the open group. However the difference had no statistical significance （P〉0. 05）. The rises of IL-6 and TNF-α in the laparoscopic group were remarkably less and slowly than that those in the open group. And the decline were more rapid in the laparoscopic group, the rise of IL-10 was marked while its decline was more rapid in the laparoscopic group than those in the open group. Conclusions LA can decrease the serum levels of pro-inflammatory cytokines IL-6 and TNF-α and increase the serum levels of anti-inflammatory cytokine IL-10. And it can reduce stress and inflammatory responses and enhance anti-inflammatory response for children with peritonitis and sepsis secondary to appendicitis perforation.