一些证据表明,过敏成分是急性阑尾炎的诱因。由于Th2免疫应答的特征是嗜酸性粒细胞动员到靶器官并释放其阳离子颗粒蛋白,研究嗜酸性粒细胞的脱颗粒是否与局部损伤有关是合理的。本研究的主要目的是评估嗜酸性粒细胞颗粒蛋白在急性阑尾炎中的参与,在局部和全身水平,次要目的是评估嗜酸性粒细胞颗粒蛋白检测急性阑尾炎的诊断准确性,以及区分复杂和不复杂的急性阑尾炎。嗜酸性粒细胞衍生的神经毒素(EDN),嗜酸性粒细胞阳离子蛋白(ECP)和嗜酸性粒细胞过氧化物酶(EP)是最熟知的嗜酸性粒细胞颗粒蛋白。从2021年8月到2022年4月,我们提出了一项前瞻性单中心研究来评估EDN,ECP,22例急性痰性阑尾炎(APA)患者的阑尾灌洗液(ALF)和血清中的EP浓度同时增加,24患有急性坏疽性阑尾炎(AGA),14个正常对照。关于EDN,组间无差异.与对照组相比,在组织学证实的急性阑尾炎中,ALF和血清中的ECP浓度显著更高(分别为p<0.0001和p<0.0001)。在ALF中,APA组的ECP水平:38.85ng/mL(IQR26.50~51.77)和AGA组51.55ng/mL(IQR39.55~70.09)之间无差异(p=0.176).在血清中,在APA:39ng/mL(IQR21.30~56.90)和AGA:51.30ng/mL(IQR20.25~62.59)时,ECP水平无差异(p=0.100).对于EP,急性阑尾炎患者ALF(p<0.001)和血清(p<0.001)的浓度均高于对照组.在ALF中,APA:240.28ng/mL(IQR191.2-341.3)和AGA:302.5(IQR227.7-535.85)之间无差异(p=0.236).在血清中,APA:158.4ng/mL(IQR111.09~222.1)和AGA:235.27(IQR192.33~262.51)之间无差异(p=0.179).全球范围内,ALF浓度高于血清浓度,反映了AA中强烈的局部炎症反应。区分急性阑尾炎和对照组的最佳ECP截止值>11.41ng/mL,灵敏度为93.5%,但识别阑尾炎的特异性为21.4%,良好的鉴别力(AUC=0.880)。对于EP,最佳截止值>93.20ng/mL,灵敏度为87%,但特异性为14.3%(AUC=0.901),优秀的鉴别力。对于穿孔AA的诊断,ECP和EP血清浓度的辨别能力较弱(AUC=0.562和AUC=0.664)。关于腹膜炎的存在,ECP和EP血清浓度的辨别能力是可以接受的,AUC=0.724和AUC=0.735。血清EDN水平(p=0.119),复杂性阑尾炎的ECP(p=0.586)和EP(p=0.08)与非复杂性阑尾炎相似。ECP和EP的血清浓度可以添加到决策AA诊断中。Th2型免疫应答存在于AA中。这些数据提出了过敏反应在急性阑尾炎发病机理中的作用。
Several pieces of evidence point to an allergic component as a trigger of acute appendicitis. As the Th2 immune response is characterized by eosinophil mobilization to the target organ and release of their cationic granule proteins, it is reasonable to investigate if the degranulation of eosinophils could be associated with the local injury. The primary aim of this study is to evaluate the participation of eosinophils granules proteins in acute appendicitis, both at local and systemic levels and the secondary aim is to evaluate the diagnostic accuracy of eosinophils granules proteins for the detection of acute appendicitis, as well as for distinguishing between complicated and uncomplicated acute appendicitis. Eosinophil-derived neurotoxin (EDN), eosinophil cationic protein (ECP) and eosinophil peroxidase (EP) are the most well-known eosinophil granule proteins. From August 2021 to April 2022, we present a prospective single-center study to evaluate the EDN, ECP, and EP concentrations simultaneously in appendicular lavage fluid (ALF) and the serum of 22 patients with acute phlegmonous appendicitis (APA), 24 with acute gangrenous appendicitis (AGA), and 14 normal controls. Concerning EDN, no differences were found between groups. ECP concentrations in ALF and serum were significantly higher in the histologically confirmed acute appendicitis compared to the control groups (p < 0.0001 and p < 0.0001, respectively). In ALF, no differences were found between ECP levels in APA: 38.85 ng/mL (IQR 26.50-51.77) and AGA 51.55 ng/mL (IQR 39.55-70.09) groups (p = 0.176). In the serum, no difference was found between ECP levels at APA: 39 ng/mL (IQR 21.30-56.90) and AGA: 51.30 ng/mL (IQR 20.25-62.59) (p = 0.100). For EP, the concentrations in ALF (p < 0.001) and serum (p < 0.001) were both higher in acute appendicitis compared to the control. In ALF, no difference was found between APA: 240.28 ng/mL (IQR 191.2-341.3) and AGA: 302.5 (IQR 227.7-535.85) (p = 0.236). In the serum, no differences were found between APA: 158.4 ng/mL (IQR 111.09-222.1) and AGA: 235.27 (IQR 192.33-262.51) (p = 0.179). Globally, the ALF concentrations were higher than serum concentrations, reflecting an intense inflammatory local reaction in AA. The optimal ECP cut-off for discriminating between acute appendicitis and the controls was >11.41 ng/mL, with a sensitivity of 93.5%, but with a specificity for identifying appendicitis of 21.4%, good discriminative power (AUC = 0.880). For EP, the optimal cut-off was >93.20 ng/mL, with a sensitivity of 87%, but with a specificity of 14.3% (AUC = 0.901), excellent discriminative power. For the diagnosis of perforated AA, the discriminative power of ECP and EP serum concentrations are weak (AUC = 0.562 and AUC = 0.664, respectively). Concerning the presence of peritonitis, the discriminative power of ECP and EP serum concentrations is acceptable, respectively: AUC = 0.724 and AUC = 0.735. Serum levels of EDN (p = 0.119), ECP (p = 0.586) and EP (p = 0.08) in complicated appendicitis were similar to uncomplicated appendicitis. Serum concentrations of ECP and EP can be added to decision-making AA diagnosis. A Th2-type immune response is present in AA. These data bring forward the role of an allergic reaction in the pathogenesis of acute appendicitis.