Gudjonsdottir Johanna, Roth Bodil, Lovén Gustav, Ohlsson Bodil, Hagander Lars, Salö Martin
Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden.
Department of Surgery, Skåne University Hospital, Malmö, Sweden.
Front Pediatr. 2022 May 2;10:884138. doi: 10.3389/fped.2022.884138. eCollection 2022.
The pathogenesis of appendicitis is not understood completely and establishing a correct diagnosis can be clinically challenging. Previous investigations have shown an association between a T helper cell (Th)2-mediated inflammatory response, for example immunoglobulin E (IgE)-mediated allergy, and a decreased risk of complicated appendicitis. The present study aimed to evaluate differences in serum concentrations of IgE and Th2-associated interleukins (IL) in children with uncomplicated and complicated appendicitis.
A prospective study including children <15 years with appendicitis. Blood samples were collected preoperatively at the time of clinical assessment at the Pediatric Emergency Department and analyzed for concentrations of serum total IgE and IL-4, IL-9, and IL-13. Associations with complicated appendicitis were evaluated through logistic regression adjusting for age, appendicolith, and symptom duration.
138 children with confirmed appendicitis were included. The median age was 10 (IQR 8-12) years, 87 (63%) were boys and 58 (42%) had complicated appendicitis. Children with complicated appendicitis had significantly higher concentrations of IL-9 and IL-13 compared to children with uncomplicated appendicitis. In the univariate logistic regression, high concentrations of IL-13 were associated with an increased risk of complicated appendicitis [OR 1.02 (95% CI 1.01-1.04) = 0.005], which remained in the multivariate analysis [aOR 1.02 (95% CI 1.01-1.04), = 0.01]. Serum concentrations of IgE, IL-4, and IL-9 did not significantly affect the risk of complicated appendicitis.
High levels of IL-13 seem to be associated with an increased risk of complicated appendicitis. This is incongruent with the hypothesis of an Th1/Th17-driven inflammation in this type of appendicitis.
阑尾炎的发病机制尚未完全明确，准确诊断在临床上具有挑战性。既往研究表明，辅助性T细胞（Th）2介导的炎症反应，如免疫球蛋白E（IgE）介导的过敏反应，与复杂性阑尾炎风险降低有关。本研究旨在评估单纯性和复杂性阑尾炎患儿血清IgE及Th2相关白细胞介素（IL）浓度的差异。
一项前瞻性研究，纳入15岁以下阑尾炎患儿。在儿科急诊科临床评估时于术前采集血样，分析血清总IgE、IL-4、IL-9和IL-13的浓度。通过对年龄、阑尾结石和症状持续时间进行校正的逻辑回归评估与复杂性阑尾炎的相关性。
纳入138例确诊阑尾炎患儿。中位年龄为10（四分位间距8 - 12）岁，87例（63%）为男孩，58例（42%）患有复杂性阑尾炎。与单纯性阑尾炎患儿相比，复杂性阑尾炎患儿的IL-9和IL-13浓度显著更高。在单变量逻辑回归中，高浓度IL-13与复杂性阑尾炎风险增加相关[比值比（OR）1.02（95%置信区间1.01 - 1.04），P = 0.005]，多变量分析中该结果仍然存在[校正后OR 1.02（95%置信区间1.01 - 1.04），P = 0.01]。血清IgE、IL-4和IL-9浓度对复杂性阑尾炎风险无显著影响。
高水平IL-13似乎与复杂性阑尾炎风险增加相关。这与该类型阑尾炎由Th1/Th17驱动炎症的假说不一致。
