新的氧化应激标志物可用于儿童急性阑尾炎的诊断：硫醇/二硫键平衡和不对称二甲基精氨酸水平。

New Oxidative Stress Markers Useful in the Diagnosis of Acute Appendicitis in Children: Thiol/Disulfide Homeostasis and the Asymmetric Dimethylarginine Level.

机构信息

From the Departments of Pediatrics.

Pediatric Surgery.

出版信息

Pediatr Emerg Care. 2020 Aug;36(8):362-367. doi: 10.1097/PEC.0000000000001339.

DOI:10.1097/PEC.0000000000001339

PMID:29135899

Abstract

OBJECTIVES

The aim of this study was to evaluate 2 new oxidative stress markers, thiol/disulfide homeostasis status and the asymmetric dimethylarginine (ADMA) level, in children with acute appendicitis (AA) and to evaluate their diagnostic utility.

METHODS

This case-control study included 45 patients with AA and 35 healthy children. Age, sex, white blood cell count, neutrophil-to-lymphocyte ratio, high-sensitivity C-reactive protein (hs-CRP) level, ultrasonographic findings, thiol/disulfide homeostasis parameters (native and total thiol levels, native thiol/total thiol ratios [antioxidant parameters], and disulfide, disulfide/native thiol, and disulfide/total thiol ratios [oxidant parameters]), and the ADMA level were compared between the 2 groups.

RESULTS

The native and total thiol levels, and the native thiol/total thiol ratio, were significantly lower, and the disulfide level and disulfide/native thiol and disulfide/total thiol ratios significantly higher, in the AA compared with the control group (all P < 0.001). The ADMA level was significantly higher in a perforated versus nonperforated subgroup of AA patients, but the thiol/disulfide homeostasis parameters did not differ significantly between the two subgroups. In addition, the hs-CRP level and appendiceal wall thickness were higher in the perforated subgroup. The thiol/disulfide antioxidant parameters and ADMA level correlated negatively with the white blood cell count, the neutrophil-to-lymphocyte ratio, and the hs-CRP level, in the AA group, but correlated positively with oxidant parameters. The sensitivity and specificity of the disulfide/native thiol and disulfide/total thiol ratios were high when used to diagnose AA, whereas the sensitivity of the ADMA level was high when used to diagnose perforated appendicitis.

CONCLUSIONS

Thiol/disulfide homeostasis and the ADMA level, together with certain other parameters, may be useful biomarkers of AA in children.

摘要

目的

本研究旨在评估 2 种新的氧化应激标志物，巯基/二硫键平衡状态和不对称二甲基精氨酸（ADMA）水平，用于评估其在儿童急性阑尾炎（AA）中的诊断价值。

方法

本病例对照研究纳入了 45 例 AA 患儿和 35 名健康儿童。比较两组间年龄、性别、白细胞计数、中性粒细胞与淋巴细胞比值、高敏 C 反应蛋白（hs-CRP）水平、超声表现、巯基/二硫键平衡参数（天然和总巯基水平、天然巯基/总巯基比值[抗氧化参数]和二硫键、二硫键/天然巯基和二硫键/总巯基比值[氧化参数]）以及 ADMA 水平。

结果

AA 组的天然和总巯基水平以及天然巯基/总巯基比值显著降低，而二硫键水平以及二硫键/天然巯基和二硫键/总巯基比值显著升高（均 P < 0.001）。穿孔性与非穿孔性 AA 亚组间 ADMA 水平差异显著，但巯基/二硫键平衡参数无显著差异。此外，穿孔性亚组的 hs-CRP 水平和阑尾壁厚度更高。AA 组中，巯基/二硫键抗氧化参数和 ADMA 水平与白细胞计数、中性粒细胞与淋巴细胞比值和 hs-CRP 水平呈负相关，与氧化参数呈正相关。二硫键/天然巯基和二硫键/总巯基比值诊断 AA 的敏感性和特异性较高，而 ADMA 水平诊断穿孔性阑尾炎的敏感性较高。