Nathan L Sanders, R Randal Bollinger, Ryan Lee, Steven Thomas, William Parker, Department of Surgery, Duke University Medical Center, Durham, NC 27710, United States.
World J Gastroenterol. 2013 Sep 14;19(34):5607-14. doi: 10.3748/wjg.v19.i34.5607.
Advances in understanding the interaction between the human immune system and the microbiome have led to an improved understanding of the function of the vermiform appendix as a safe-house for beneficial bacteria in the colon. These advances have been made despite long standing clinical observations that the appendectomy is a safe and effective procedure. However, more recent clinical data show that an appendectomy puts patients at increased risk for recurrent Clostridium difficile (C. difficile)-associated colitis, and probably other diseases associated with an altered microbiome. At the same time, appendectomy does not apparently put patients at risk for an initial onset of C. difficile-associated colitis. These clinical observations point toward the idea that the vermiform appendix might not effectively protect the microbiome in the face of broad spectrum antibiotics, the use of which precedes the initial onset of C. difficile-associated colitis. Further, these observations point to the idea that historically important threats to the microbiome such as infectious gastrointestinal pathogens have been supplanted by other threats, particularly the use of broad spectrum antibiotics.
尽管长期以来的临床观察表明阑尾切除术是一种安全有效的手术，但对人类免疫系统和微生物组之间相互作用的理解的进展使人们更好地了解了阑尾作为结肠内有益细菌的安全居所的功能。然而，最近的临床数据表明，阑尾切除术会增加患者罹患复发性艰难梭菌（C. difficile）相关性结肠炎的风险，可能还会增加与微生物组改变相关的其他疾病的风险。与此同时，阑尾切除术似乎不会使患者面临初次罹患艰难梭菌相关性结肠炎的风险。这些临床观察表明，在广谱抗生素的作用下，阑尾可能无法有效保护微生物组，而广谱抗生素的使用则先于艰难梭菌相关性结肠炎的初次发作。此外，这些观察结果表明，过去对微生物组构成重要威胁的因素，如传染性胃肠道病原体，已经被其他威胁所取代，尤其是广谱抗生素的使用。
