Kubikova E, Sivakova I, Perzelova A, Falougy H El
Bratisl Lek Listy. 2015;116(12):726-8. doi: 10.4149/bll_2015_138.
Although appendicitis is a common disease, basic questions about risk factors and its etiology remain unexplained.
An obstruction of the appendix lumen is usually considered to be the main cause of acute appendicitis. However, more studies are currently dealing with neuroimmune appendicitis.
We studied samples of human appendices with the histological diagnosis of chronic appendicitis. Fixed cryosections of appendiceal walls were examined by immunofluorescence methods using neuronal anti-neurofilament antibody markers and beta III tubulin.
The immunostaining revealed an irregular distribution of myenteric ganglia in inflamed appendiceal walls and unexpected groups of large ganglia unequally distributed in the subserosal area. The comparative analysis of normal and inflamed appendix samples showed differences in the occurrence of myenteric ganglia in the subserosal area. They appeared more frequently on cryosections prepared from the inflamed appendiceal wall.
We propose that the high variability and irregular location of myenteric ganglia in the appendiceal wall are due to an alteration in the motility which results in flaccid appendix emptying. In addition, superficially located myenteric ganglia are exposed to abdominal irritation and may explain the chronic abdominal pain which is often considered to be a sign of chronic appendicitis (Fig. 2, Ref. 23).
尽管阑尾炎是一种常见疾病，但关于其危险因素和病因的基本问题仍未得到解释。
阑尾腔梗阻通常被认为是急性阑尾炎的主要病因。然而，目前有更多研究在探讨神经免疫性阑尾炎。
我们研究了经组织学诊断为慢性阑尾炎的人体阑尾样本。使用神经元抗神经丝抗体标记物和βⅢ微管蛋白，通过免疫荧光法检查阑尾壁的固定冰冻切片。
免疫染色显示，在发炎的阑尾壁中，肌间神经节分布不规则，并且在浆膜下区域出现了意想不到的大神经节群，分布不均。正常阑尾样本与发炎阑尾样本的对比分析显示，浆膜下区域肌间神经节的出现存在差异。它们在发炎阑尾壁制备的冰冻切片上出现得更频繁。
我们认为，阑尾壁中肌间神经节的高度变异性和不规则位置是由于蠕动改变导致阑尾排空松弛所致。此外，位于表面的肌间神经节受到腹部刺激，这可能解释了常被认为是慢性阑尾炎症状的慢性腹痛（图2，参考文献23）。
