Ünsal Abdulkadir, Yavuz Alper, Buluş Hakan, Aydın Altan, Alışık Murat, Erel Özcan
General Surgery, University of Health Sciences, Atatürk Sanatoryum Training and Research Hospital, Ankara, TUR.
General Surgery, University of Health Sciences, Trabzon Kanuni Training and Research Hospital, Trabzon, TUR.
Cureus. 2022 Sep 7;14(9):e28891. doi: 10.7759/cureus.28891. eCollection 2022 Sep.
Background Acute appendicitis is one of the events most frequently encountered by general surgeons. Despite the high incidence, serious problems are experienced in the diagnosis and clinical follow-up. In the pathogenesis of the disease, oxidative stress and impaired antioxidant defense mechanisms created in the body by this stress play an important role. As dynamic thiol-disulfide hemostasis is closely related to oxidative stress and is known to have a crucial role in the pathogenesis of oxidative stress, this study aimed to compare its value with other inflammatory markers in the diagnosis and follow-up of acute appendicitis. Methodology This study included cases admitted for surgery with a diagnosis of acute abdomen at Keçiören Research and Training Hospital General Surgery Clinic between April 2015 and July 2015 who were intraoperatively diagnosed with acute appendicitis and underwent routine appendectomy. In the preoperative period and after clinical healing before discharge, blood samples were obtained to examine white blood cell (WBC), mean platelet volume (MPV), total bilirubin, C-reactive protein (CRP), and thiol-disulfide balance, and the results were recorded. Results A total of 68 cases were operated on for acute appendicitis, and 59 were evaluated comprising 23 (39%) females and 36 (61%) males with a mean age of 35.6 years (range = 19-65 years). The mean duration of hospital stay was two days (range = 1-8 days). The results of the tests performed preoperatively and before discharge and their p-values were as follows: native thiol (-SH) 393.5 ± 9.4 µmol/L and 369.3 ± 9.5 µmol/L (p = 0.04), total thiol 434 ± 9.7 µmol/L and 396.7 ± 10.2 µmol/L (p = 0.03), disulfide (-S-S) 16.8 ± 0.7 µmol/L and 15.7 ± 0.9 µmol/L (p = 0.3), WBC 13.2 ± 0.5 × 10³/mL and 9.2 ± 0.4 × 10³/mL (p = 0.0), CRP 8.17 ± 1.24 mg/L and 7.84 ± 0.82 mg/L (p = 0.17), MPV 7.4 ± 0.37 fL and 7.97 ± 0.19 fL (p = 1.0), and total bilirubin 0.86 ± 0.08 mg/dL and 0.69 ± 0.06 mg/dL (p = 0.08). Conclusions In the clinical follow-up of acute appendicitis patients, the decrease in WBC, total thiol, and native thiol values can be helpful to clinicians as markers of clinical healing. However, CRP may not be a useful marker of clinical healing in acute appendicitis patients who are discharged early.
背景 急性阑尾炎是普通外科医生最常遇到的病症之一。尽管发病率很高，但在诊断和临床随访中仍存在严重问题。在该疾病的发病机制中，氧化应激以及由此应激在体内产生的抗氧化防御机制受损起着重要作用。由于动态硫醇 - 二硫键稳态与氧化应激密切相关，并且已知在氧化应激的发病机制中起关键作用，本研究旨在比较其在急性阑尾炎诊断和随访中与其他炎症标志物的价值。
方法 本研究纳入了2015年4月至2015年7月在凯奇奥伦研究与培训医院普通外科门诊因诊断为急腹症而入院接受手术且术中诊断为急性阑尾炎并接受常规阑尾切除术的病例。在术前和出院前临床愈合后，采集血样以检测白细胞（WBC）、平均血小板体积（MPV）、总胆红素、C反应蛋白（CRP）和硫醇 - 二硫键平衡，并记录结果。
结果 共有68例患者接受了急性阑尾炎手术，59例纳入评估，其中女性23例（39%），男性36例（61%），平均年龄35.6岁（范围 = 19 - 65岁）。平均住院时间为两天（范围 = 1 - 8天）。术前和出院前进行的检测结果及其p值如下：天然硫醇（-SH）393.5±9.4μmol/L和369.3±9.5μmol/L（p = 0.04），总硫醇434±9.7μmol/L和396.7±10.2μmol/L（p = 0.03），二硫键（-S-S）16.8±0.7μmol/L和15.7±0.9μmol/L（p = 0.3），WBC 13.2±0.5×10³/mL和9.2±0.4×10³/mL（p = 0.0），CRP 8.17±1.24mg/L和7.84±0.82mg/L（p = 0.17），MPV 7.4±0.37fL和7.97±0.19fL（p = 1.0），总胆红素0.86±0.08mg/dL和0.69±0.06mg/dL（p = 0.08）。
结论 在急性阑尾炎患者的临床随访中，白细胞、总硫醇和天然硫醇值的降低作为临床愈合的标志物可能对临床医生有帮助。然而，对于早期出院的急性阑尾炎患者，CRP可能不是临床愈合的有用标志物。
