Petroianu Andy, Barroso Thiago Vinicius Villar, Buzelin Marcelo Araújo, Theobaldo Bárbara De Melo, Tafuri Luciene Simões De Assis
Department of Surgery, School of Medicine, Federal University of Minas Gerais, Brazil.
Ann Med Surg (Lond). 2020 Nov 6;60:344-351. doi: 10.1016/j.amsu.2020.10.044. eCollection 2020 Dec.
About 15%-25% of appendices removed to treat acute appendicitis present normal macro- and macroscopic morphology. The objective of this study was to verify an association of proinflammatory, neuroendocrine and immune mediators with morphologically normal appendices removed from patients with clinical laboratorial and imaging characteristics of acute appendicitis.
Appendices removed from 121 adult patients of both genders were distributed into three groups according to their following characteristics: group 1: 53 macro- and microscopically normal appendices from patients with clinical, laboratorial and imaging diagnosis of acute appendicitis; group 2: 24 inflamed appendices from patients with clinical, laboratorial, imaging and histopathological diagnosis of acute appendicitis; group 3: 44 normal appendices from patients submitted to right colectomy to treat localized ascending colon adenocarcinoma. All appendices were immunohistochemically studied for gastrin inhibitor peptide, mast cell tryptase, vascular endothelial growth factor; intestinal vasoactive peptide, tumor necrosis factor alpha, interleukin 1, prostaglandin E2, gene-protein product 9.5, CD8 T lymphocytes, synaptophysine, enolase, and S100 protein.
The group 1 revealed increased levels of synaptophysine, enolase, mast cell tryptase and PGP-9.5 comparing with the other two groups. The group 2 presented increased levels of interleukin 1, CD8 T lymphocytes and prostaglandin E2 comparing with the other two groups. The group 3 confirmed the normal levels of all these neuroendocrine, immune and proinflammatory mediators.
Morphologically normal appendices removed from patients with clinical and complementary exams indicating acute appendicitis have appendicular neuroimmunoendocrine disorder associated with the mediators synaptophysin, enolase, mast cell-related tryptase and gene-protein product 9.5.
在因治疗急性阑尾炎而切除的阑尾中，约15%-25%的阑尾在大体和微观形态上正常。本研究的目的是验证促炎介质、神经内分泌介质和免疫介质与从具有急性阑尾炎临床、实验室和影像学特征的患者身上切除的形态正常的阑尾之间的关联。
将121例成年男女患者切除的阑尾根据以下特征分为三组：第1组：53例来自临床、实验室和影像学诊断为急性阑尾炎患者的大体和显微镜下均正常的阑尾；第2组：24例来自临床、实验室、影像学和组织病理学诊断为急性阑尾炎患者的发炎阑尾；第3组：44例因治疗局限性升结肠癌而接受右半结肠切除术患者的正常阑尾。所有阑尾均进行免疫组织化学研究，检测胃泌素抑制肽、肥大细胞类胰蛋白酶、血管内皮生长因子、肠血管活性肽、肿瘤坏死因子α、白细胞介素1、前列腺素E2、基因蛋白产物9.5、CD8 T淋巴细胞、突触素、烯醇化酶和S100蛋白。
与其他两组相比，第1组的突触素、烯醇化酶、肥大细胞类胰蛋白酶和PGP-9.5水平升高。与其他两组相比，第2组的白细胞介素1、CD8 T淋巴细胞和前列腺素E2水平升高。第3组证实所有这些神经内分泌、免疫和促炎介质水平正常。
从临床及辅助检查提示为急性阑尾炎的患者身上切除的形态正常的阑尾存在阑尾神经免疫内分泌紊乱，与突触素、烯醇化酶、肥大细胞相关类胰蛋白酶和基因蛋白产物9.5等介质有关。
