Sobczak Jarosław, Burzyńska Monika, Sikora Anna, Wysocka Anna, Karawani Jakub, Sikora Janusz P
Department of Paediatric Emergency Medicine, 2nd Chair of Paediatrics, Central Clinical Hospital, Medical University of Łódź, ul. Sporna 36/50, 91-738 Łódź, Poland.
Department of Management and Logistics in Healthcare, Medical University of Łódź, ul. Lindleya 6, 90-131 Łódź, Poland.
Biomedicines. 2023 Jul 2;11(7):1880. doi: 10.3390/biomedicines11071880.
Acute appendicitis is an inflammatory process which is one of the most frequent global causes of surgical interventions in children. The goal of the study was to determine whether acute phase proteins, that is, C-reactive protein (CRP), procalcitonin (PCT) and neutrophil gelatinase-associated lipocalin (NGAL), interleukin 6 (IL-6), transforming growth factor-beta1 (TGF-β1) and cortisol (HC) play a role in the pathomechanism of post-trauma stress response of the organism and to establish the impact of the applied surgical procedure and/or of inflammation on their concentrations. An additional purpose was to establish the clinical usefulness of the studied biomarkers in the diagnostics of appendicitis. CRP concentrations were quantified via the immunoturbidimetric method, while the levels of IL-6 and PCT were assessed using a bead-based multiplexed immunoassay system in a microplate format (Luminex xMAP technology); NGAL, TGF-β1 and cortisol concentrations were determined via the enzyme-linked immunosorbent assay (ELISA) technique. All the investigated biomarkers were assayed twice, i.e., immediately before the surgery and 12-24 h after its completion. Significant increases in CRP, IL-6 and PCT concentrations were found in all children subjected to laparoscopic surgeries ( = 0.001, = 0.006, and = 0.009, respectively) and open (classic) surgeries ( = 0.001, = 0.016, and = 0.044, respectively) compared to the initial concentrations. The patients undergoing classical surgery moreover presented with significant ( = 0.002, and = 0.022, respectively) increases in NGAL and TGF-β1 levels after the procedures. In a group of children undergoing laparoscopic surgery, the appendicitis induced an increase in cortisol concentration, whereas in patients undergoing classical surgery the increase in the levels of this biomarker was caused by the type of performed surgical procedure. Simultaneously assaying the levels of CRP, NGAL and IL-6 ( = 0.008, = 0.022, and = 0.000, respectively) may prove useful in clinical practice, enabling the diagnosis of appendicitis in paediatric patients reporting to a hospital with abdominal pains, in addition to data from anamnesis and from clinical or ultrasound examination. The performed study confirms the participation of examined biomarkers in the pathomechanism of post-injury stress reaction of the organism to surgical trauma.
急性阑尾炎是一种炎症性疾病，是全球儿童外科手术最常见的病因之一。本研究的目的是确定急性期蛋白，即C反应蛋白（CRP）、降钙素原（PCT）、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、白细胞介素6（IL-6）、转化生长因子-β1（TGF-β1）和皮质醇（HC）是否在机体创伤后应激反应的发病机制中起作用，并确定所应用的外科手术和/或炎症对其浓度的影响。另一个目的是确定所研究的生物标志物在阑尾炎诊断中的临床实用性。CRP浓度通过免疫比浊法进行定量，而IL-6和PCT水平则使用微孔板形式的基于磁珠的多重免疫分析系统（Luminex xMAP技术）进行评估；NGAL、TGF-β1和皮质醇浓度通过酶联免疫吸附测定（ELISA）技术测定。所有研究的生物标志物均进行两次检测，即在手术前即刻以及手术完成后12 - 24小时。与初始浓度相比，所有接受腹腔镜手术的儿童（分别为 = 0.001、 = 0.006和 = 0.009）以及接受开放（经典）手术的儿童（分别为 = 0.001、 = 0.016和 = 0.044）的CRP、IL-6和PCT浓度均显著升高。此外，接受经典手术的患者术后NGAL和TGF-β1水平也显著升高（分别为 = 0.002和 = 0.022）。在接受腹腔镜手术的儿童组中，阑尾炎导致皮质醇浓度升高，而在接受经典手术的患者中，该生物标志物水平的升高是由所实施的手术类型引起的。同时检测CRP、NGAL和IL-6的水平（分别为 = 0.008、 = 0.022和 = 0.000）在临床实践中可能是有用的，除了病史、临床或超声检查数据外，还能帮助诊断因腹痛到医院就诊的儿科患者是否患有阑尾炎。所进行的研究证实了所检测的生物标志物参与了机体对手术创伤的损伤后应激反应的发病机制。
