Background
Increasing circumstantial evidence suggests that not all patients with appendicitis
will progress to perforation and that appendicitis that resolves may be a common event.
Based on this theory and on indications of aberrant regulation of inflammation in
gangrenous appendicitis, we hypothesized that phlegmonous and gangrenous appendicitis
are different entities with divergent immunoregulation.
Methods
Blood samples were collected from patients with gangrenous appendicitis (n = 16), phlegmonous appendicitis (n = 21), and nonspecific abdominal pain (n = 42). Using multiplex bead arrays, we analyzed a range of inflammatory markers,
such as interleukin (IL)-1ra, IL-1rβ, IL-2, IL-6, IL-10, IL-12p70, IL-15, and IL-17;
interferon-γ; tumor necrosis factor; CXCL8; CCL2; CCL3; and matrix metalloproteinase
(MMP)-1 MMP-2, MMP-3, MMP-7, MMP-8, MMP-9, MMP-12, and MMP-13 in blood.
Results
Compared with patients with phlegmonous appendicitis and nonspecific abdominal pain,
the patients with gangrenous appendicitis had increased levels of the proinflammatory
markers IL-6, CCL2, IL-17, MMP-8, and MMP-9 (P ≤ .04 each) accompanied by increased levels of the anti-inflammatory cytokines IL-1ra
and IL-10 (P ≤ .02). Patients with phlegmonous appendicitis had increased levels of IL-10 only.
Conclusion
The finding of a pattern of inflammatory markers compatible with the highly inflammatory
Th17 subset in sera from patients with gangrenous appendicitis, but not in phlegmonous
appendicitis, supports the hypothesis that gangrenous and phlegmonous appendicitis
are different entities with divergent immune regulation. Additional studies of the
differential immunopathogenesis of phlegmonous and gangrenous appendicitis are warranted,
as this may have important implications in the diagnosis and management of patients
with suspicion of appendicitis.
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Article info
Publication history
Published online: November 06, 2009
Accepted:
September 29,
2009
Footnotes
Supported by grants from the Health Research Council in Southeast Sweden (FORSS).
The work was supported by grants from the Health Research Council in Southeast Sweden (FORSS).
Identification
Copyright
© 2010 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
