摘要目的 研究感染对阑尾Cajal间质细胞(interstitial cells of Cajal,ICCs)表型的影响.方法 收集2008年1月至6月间我科收治64例化脓性阑尾炎和24例阑尾炎穿孔伴腹膜炎为病例组,并以17例阑尾脓肿治愈后6个月再次手术及非炎症性阑尾切除15例患儿作为对照.取阑尾全层组织行HE染色及c-Kit+免疫组织化学染色(Envision二步法),对照分析阑尾ICCs的c-Kit+表达情况,并同时分析4组患儿C反应蛋白(CRP)和前降钙素(PCT)的改变.结论 c-Kit+ICCs在脓肿后组分布较均匀,ICCs间距小,构成网络状结构.脓肿后组与对照组差异无统计学意义(P＝0.687);化脓组、腹膜炎组均分别较对照组明显减少,网络状结构破坏,差异有统计学意义(P＜0.001),腹膜炎组ICCs较化脓组减少更明显,差异有统计学意义(P＜0.001).CRP在化脓组(28.7±8.4)mg/L、腹膜炎组(116.1±34.3) mg/L较脓肿后组(2.8±0.6)mg/L均有明显升高(P＜0.001),腹膜炎组较化脓组升高更明显(P＜0.001),脓肿后组与对照组(2.2±0.4)mg/L均在正常范围;PCT在化脓组(0.96±0.31) ng/ml、腹膜炎组(2.08±0.59ng/ml)较脓肿后组(0.32±0.09)ng/ml均有明显升高(P＜0.001),腹膜炎组较化脓组升高更明显(P＜0.001),脓肿后组与对照组(0.17±0.04)ng/ml均在正常范围.结论 感染与阑尾ICCs表型改变有关,感染越重c-Kit+ICCs减少越明显.感染控制后ICCs表型可恢复,网络状结构重新建立.

abstractsObjective To investigate the phenotypic alterations of interstitial cells of Cajal(ICCs) in children with appendicitis.Methods Appendectomy specimens and the levels of CRP and PCT from 64 patients with suppurative appendicitis(suppurative group),24 patients of perforated appendicitis with peritonitis(peritonitis group) and 17 patients with appendiceal abscess accepted conservative treatment and then with elective interval appendectomy 6 months later(abscess group) were respectively compared with appendectomy specimens and CRP and PCT from 15 control patients with congenital malrotation of intestine(control group).We investigated the ICCs distribution in 120 appendices of these patients using immunohistochemistry and anti-c-kit antibodies.Results Compared to control group,c-Kit+ICCs were abundant and showed a network structure in the appendices of abscess group and there was no significant difference between them.The number of c-kit+ ICCs was remarkably reduced or even disappeared and the network structures was destroyed in the both suppurative group and peritonitis group,and were significant less than those of the controls,there was a significant difference between suppurative group and peritonitis group in the distribution of c-Kit+ICCs.The CRP and PCT were significantly elevated in suppurative group (28.7±8.4mg/L,0.96±0.31ng/ml)and peritonitis group (116.1±34.3mg/L,2.08±0.59ng/ml),but maintained in normal levels in abscess group(2.8±0.6mg/L,0.32±0.09ng/ml).Conclusions Infection might lead to temporary losses of the phenotype and the network structure of ICCs,but these alterations can be recovered with recession of infection.