Study On Bacterial Translocation In Acute Appendicitis In Children

objectives To explore the occurrence of bacterial translocation in acute appendicitis in children,to investigate the relationship between bacterial translocation and the appendix tissue nitric oxide synthase (NOS),serum nitric oxide (NO) ,interleukin 10(IL-10)in acute appendicitis in children and its implication.Methods In 30 children with acute appendicitis,blood samples were collected before surgery and 7 day after surgery; peritoneal fluid and mesenteric lymph node were collected before appendectomy.10 children with intestinal malrotation without appendicitis and 10 healthy subjects were studied as controls. Microbial DNA(16SrRNA shared by al1 bacteria and E.coli BG ) were detected by using polymerase chain reaction (PCR). Peritoneal fluid and mesenteric lymph node were cultured bacteria. Appendix tissue nitric oxide synthase (NOS) staining intensity were measured by using immunohistochemistry.The levels of NO and IL-10 were measured by using Enzyme-linked immunosorbent assay (ELISA).Results In the control group and acute simple appendicitis pre-operative group and after-operative groups, microbial DNA were negative ;in the acute simple appendicitis group ,bacterial culture of peritoneal fluid and mesenteric lymph node were negative,too. In the suppurative appendicitis pre-operative group,the positive rate of 16SrRNA was 70%,its of BG was 60%, in bacterial culture of mesenteric lymph node, the positive rate of E.coli was 50%,however, its of peritoneal fluid was 40%,children with positive E.coli bacterial culture of mesenteric lymph node had positive microbial DNA of BG.In appendicitis groups, tissue NOS staining intensity were different from the control group, statistically significant (P <0.01), they were significant within groups(P <0.01).In appendicitis pre-operative groups ,the concentration of NO and IL-10 and WBC and tempreture were different from appendicitis after-operative groups(P <0.05),they were statistically higher than the control group(P <0.01),there were significant difference within appendicitis pre-operative groups(P <0.01), no statistically significant difference was observed between the control group and the after-operative groups(P >0.05). Issue NOS staining intensity in BG positive children were statistically lower than in those BG negative children(P <0.01), however,the concentration of NO and IL-10 and WBC and tempreture of them were statistically higher than in those BG negative children(P <0.05). Tissue NOS staining intensity and the concentration of NO were negatively correlated(r=-0.858, P <0.01);the concentration of NO and IL-10 were positively correlated(r=0.698, P <0.01);the concentration of NO and WBC were positively correlated(r=0.731, P <0.01).Conclusions In the acute appendicitis in children, E.coli maybe occur bacterial translocation. With increase disease,incidence of bacterial translocation and SIRS is increased.Bacterial translocation may have a close relationship with NO,so NO may be a gut barrier injury factor and a important cytokine occuring bacterial translocation . IL-10 is a anti-inflammatory cytokine and has anti-inflammatory reaction capability and maitains immue balance,so it may inhibit SIRS and MODS. The timely detection of microbial DNA may help early diagnosis in the occurrence of bacterial translocation in acute appendicitis in children, NO and IL-10 may be a prognosis indicator.