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2019, vol. 76, br. 9, str. 898-905
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Neutrofilni mijeloperoksidazni indeks u akutnom apendicitisu kod dece
Neutrophil myeloperoxidase index in pediatric acute appendicitis
Stanković Nikolaa, Đorđević Draganb, Rondović Goranb, Kostić Zoranc, Zeba Snježanab, Milosavljević Snežanad, Savić Đorđee, Miličković Majae, Grujić Blagojee, Đuričić Slavišaf  , Milanović Marijanag, Stanojević Ivanh
aUniverzitet u Beogradu, Medicinski fakultet, Institut za zdravstvenu zaštitu majke i deteta Republike Srbije 'Dr Vukan Čupić' + Univerzitet u Beogradu, Medicinski fakultet bVojnomedicinska akademija, Klinika za anesteziologiju i intenzivnu terapiju, Beograd + Univerzitet odbrane, Medicinski fakultet Vojnomedicinske akademije, Beograd cUniverzitet odbrane, Medicinski fakultet Vojnomedicinske akademije, Beograd + Vojnomedicinska akademija, Klinika za opštu hirurgiju, Beograd dUniverzitet u Prištini sa privremenim sedištem u Kosovskoj Mitrovici, Medicinski fakultet, Kliničko-bolnički centar eUniverzitet u Prištini sa privremenim sedištem u Kosovskoj Mitrovici, Medicinski fakultet, Kliničko-bolnički centar + Univerzitet u Beogradu, Medicinski fakultet, Institut za zdravstvenu zaštitu majke i deteta Republike Srbije 'Dr Vukan Čupić' fUniverzitet u Beogradu, Medicinski fakultet, Institut za zdravstvenu zaštitu majke i deteta Republike Srbije 'Dr Vukan Čupić' + Univerzitet u Banjoj Luci, Medicinski fakultet, Republika Srpska, BiH gVojnomedicinska akademija, Institut za medicinska istraživanja, Beograd hUniverzitet odbrane, Medicinski fakultet Vojnomedicinske akademije, Beograd + Vojnomedicinska akademija, Institut za medicinska istraživanja, Beograd
e-adresa: kokanasta@gmail.com
Sažetak
Uvod/Cilj. Dijagnoza akutnog apendicitisa (AA) i dalje ostaje jedna od najčešćih dilema u radu pedijatrijskog hiruškog tima. Naš cilj je bio da se ispita da li mijeloperoksidazni indeks (MPXI), u kombinaciji sa drugim laboratorijskim i kliničkim parametrima, može biti koristan u dijagnostici AA kod dece. Metode. Sprovedeno je prospektivno ispitivanje vrednosti MPXI kod 117 bolesnika, planiranih za hirušku intervenciju zbog AA. Bolesnici su bili podeljeni u tri grupe: normalni/rani, nekomplikovani (flegmonozni) i komplikovani (gangrenozni i/ili perforativni) AA. Laboratorijska ispitivanja vršena su preoperativno, kao i prvog i trećeg postoperativnog dana. Rezultati. Utvrđena je statistički značajna razlika u vrednosti MPXI između nekomplikovanog i komplikovanog apendicitisa, preoperativno. Ispitivanjem korelacije MPXI sa drugim laboratorijskim i kliničkim parametrima, utvrđena je korelacija sa C-reaktivnim proteinom i interleukinom 6, preoperativno. Postoperativno, i u grupi nekomplikovanog, kao i komplikovanog AA, zabeležen je značajan pad vrednosti MPXI. Zaključak. Širok opseg referentnih vrednosti i individualne razlike u vrednostima MPXI kod zdrave dece, ograničavaju upotrebu MPXI u dijagnostici akutnog apendicitisa kod dece. Odložena dijagnostika AA smanjuje upotrebnu vrednost MPXI.
Abstract
Background/Aim. Diagnosis of acute appendicitis (AA) remains the most common dilemma of pediatric surgical team. Our aim was to determine whether the neutrophil myeloperoxidase index (MPXI), in combination with other laboratory and clinical parameters, can be useful in diagnosis and follow-up of AA in children. Methods. A prospective investigation of MPXI values in 117 consecutive patients, planned for the surgical intervention due to AA, was performed. The patients were stratified into three groups according to the intraoperative finding: the normal/early, uncomplicated and complicated AA. Laboratory analyses were done preoperativly, on the 1st and on the 3rd postoperative days. Results. The statistically significant difference of MPXI values between the uncomplicated and complicated appendicitis before surgery and the positive correlations between the MPXI and C-reactive protein, as well as interleukin-6, before surgery were found. Postoperatively, in the group of uncomplicated, as well as complicated AA, a significant decrease of MPXI was recorded. Conclusion. The MPXI may be used as an informative biomarker in the follow-up of AA in children. A wide reference range for the MPXI and individual differences in the values of MPXI in the healthy children, generate difficulties for its use for the initial diagnosis of acute appendicitis. Usefulness of MPXI determination decreases with a delayed diagnosis.
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