[1]高 勇,徐 珂.血清学指标检测联合Alvarado评分对儿童复杂性阑尾炎诊断及其预后价值分析[J].陕西医学杂志,2022,51(8):1016-1020.[doi:DOI:10.3969/j.issn.1000-7377.2022.08.026]
　GAO Yong,XU Ke.Diagnostic and prognostic value of serological indexes combined with Alvarado score in children with complicated appendicitis[J].,2022,51(8):1016-1020.[doi:DOI:10.3969/j.issn.1000-7377.2022.08.026]
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血清学指标检测联合Alvarado评分对儿童复杂性阑尾炎诊断及其预后价值分析
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
51
期数:
2022年8期
页码:
1016-1020
栏目:
临床检验
出版日期:
2022-08-05

文章信息/Info

Title:
Diagnostic and prognostic value of serological indexes combined with Alvarado score in children with complicated appendicitis
作者:
高 勇; 徐 珂
(宝鸡市妇幼保健院小儿外科,陕西 宝鸡 721000)
Author(s):
GAO Yong; XU Ke
(Department of Pediatric Surgery,Maternal and Child Health Hospital of Baoji,Baoji 721000,China)
关键词:
急性阑尾炎;  复杂性阑尾炎;  Alvarado评分;  血清学;  诊断;  预后
Keywords:
Acute appendicitis;  Complex appendicitis;  Alvarado score;  Serology;  Diagnosis;  Prognosis
分类号:
R 726.5
DOI:
DOI:10.3969/j.issn.1000-7377.2022.08.026
文献标志码:
A
摘要:
目的:探讨血清学指标联合Alvarado评分对儿童复杂性阑尾炎(CA)的诊断效能以及和患儿预后的相关性。方法:选择148例急性阑尾炎(AA)患儿作为研究对象,根据术中所见及术后病理检查结果分为单纯性阑尾炎(SA)和CA,分别为69例和79例。采用单因素和Logistic多因素回归分析从患儿基本资料(年龄、性别、体重、病程及Alvarado评分)以及入院时血液学指标[白细胞(WBC)、中性粒细胞(NEUT)、中性粒细胞百分比(PN)、淋巴细胞(L)、血小板(PLT)、ALB白蛋白(ALB)、C反应蛋白(CRP)、降钙素原(PCT)]筛选CA独立影响因素,并采用受试者工作特征曲线评估各指标对CA的诊断价值。比较CA患儿术后有无并发症与血清指标和Alvarado评分的差异。结果:CA组患儿外周血WBC、NEUT、CRP、PCT水平和Alvarado评分显著高于SA组,ALB显著低于SA组(均P<0.05)。Logistic多因素回归结果表明,CRP、PCT和Alvarado评分是CA的独立危险因素,ALB是CA的保护因素(均P<0.05)。CRP、PCT和Alvarado评分诊断CA的AUC分别为0.798(95%CI:0.731～0.865)、0.877(95%CI:0.810～0.921)和0.764(95%CI:0.691～0.838)。以CRP>41.5 mg/L或Alvarado评分>7分诊断儿童CA的敏感度、特异度、阳性预测值和阴性预测值分别为86.08%、46.38%、64.76%和74.42%。以PCT>0.55 ng/L或Alvarado评分>7分诊断儿童CA的敏感度、特异度、阳性预测值和阴性预测值分别为89.87%、50.72%、67.62%和81.40%。79例CA患儿中有14例出现术后并发症,有并发症组CRP、PCT水平和Alvarado评分显著高于无并发症组(均P<0.05)。结论:外周血CRP、PCT以及Alvarado评分对儿童CA有一定诊断价值,其中PCT联合Alvarado评分敏感度更高,可在临床上加以进一步验证和使用。
Abstract:
Objective:To investigate the diagnostic efficacy of serological indexes combined with Alvarado score in children with complex appendicitis(CA)and its correlation with prognosis.Methods:A total of 148 children with acute appendicitis(AA)were selected as the research objects.According to the intraoperative findings and postoperative pathological examination results,they were divided into simple appendicitis group(SA group)and CA group,with 69 cases and 79 cases respectively.Univariate and Logistic regression analysis was used to screen for independent influencing factors of CA from basic data(age,sex,weight,course of disease and Alvarado score)and hematological parameters at admission [white blood cell(WBC),neutrophil(NEUT),neutrophil percentage(PN),lymphocyte(L),platelet(PLT),albumin(ALB),C-reactive protein(CRP)and procalcitonin(PCT)],and the receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of each index in CA.Results:The levels of WBC,NEUT,CRP,PCT and Alvarado score in peripheral blood of CA group were significantly higher than those of SA group,and ALB was significantly lower than that of SA group(all P<0.05).Logistic regression showed that CRP,PCT and Alvarado score were independent risk factors for CA,and ALB was protective factor for CA(all P<0.05).ROC curve analysis showed that the AUC of CRP,PCT and Alvarado score for CA diagnosis were 0.798(95%CI:0.731 to 0.865),0.877(95%CI:0.810 to 0.921)and 0.764(95%CI:0.691 to 0.838)respectively; the sensitivity,specificity,positive predictive value and negative predictive value for the diagnosis of CA in children with CRP>41.5 mg/L or Alvarado score>7 were 86.08%,46.38%,64.76% and 74.42%,respectively; the sensitivity,specificity,positive predictive value and negative predictive value for the diagnosis of CA in children with PCT>0.55 ng/L or Alvarado score>7 were 89.87%,50.72%,67.62% and 81.40%,respectively.Postoperative complications occurred in 14 of 79 children with CA,and CRP,PCT and Alvarado score were significantly higher in children with complications than those in children without complications(all P<0.05).Conclusion:CRP,PCT and Alvarado score in peripheral blood have certain diagnostic value for CA in children.PCT combined with Alvarado score is more sensitive,which can be further verified and used in clinical practice.

参考文献/References:

[1] 林丽萍,钟晓红,李胜利,等.儿童急性阑尾炎的病理分型与超声声像对照分析[J].中国超声医学杂志,2020,36(7):646-650.
[2] 洪 荣,叶建林.儿童急性阑尾炎抗感染方案的研究进展[J].药学与临床研究,2019,27(2):117-119.
[3] 王志华,赵亚娟,王 欣,等.儿童急性阑尾炎非手术治疗失败的危险因素分析[J].天津医药,2020,48(8):757-760.
[4] 彭登远.高频超声联合Alvarado评分系统在急性阑尾炎患儿中的诊断价值[J].河南医学研究,2019,28(6):144-146.
[5] 李天雨.观察尿常规检验与C-反应蛋白(CRP)诊断小儿急性阑尾炎的价值及意义[J].当代医学,2021,27(1):54-56.
[6] 张培培,颜 伟,曾 智,等.急性阑尾炎患者白细胞分类计数诊断价值及验证[J].南方医科大学学报,2015,35(2):306-308.
[7] Malik AA,Wani NA.Continuing diagnostic challenge of acute appendicitis:Evaluation through modified alvarado score[J].Anz Journal of Surgery,2010,68(7):504-505.
[8] Svensson JF,Patkova B,Almstr M,et al.Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children:A pilot randomized controlled trial[J].Ann Surg,2015,261(1):67-71.
[9] 许慧君,王光霞.高频超声对不同病理类型急性阑尾炎及并发症的诊断价值[J].中国中西医结合外科杂志,2019,25(2):145-150.
[10] 张方正.高频彩色多普勒超声诊断鉴别小儿肠系膜淋巴结炎和急性阑尾炎准确率分析[J].中国药物与临床,2020,20(18):3013-3014.
[11] 刘嘉芬,黄白沙,潘碧琦,等.大黄牡丹汤保留灌肠对小儿急性阑尾炎腹腔镜术后围手术期加速康复疗效观察[J].陕西中医,2020,41(7):923-925.
[12] 覃福星.C-反应蛋白、白细胞计数、中性粒细胞比率评价小儿急腹症的临床价值[J].齐齐哈尔医学院学报,2010,31(11):1721-7724.
[13] Monsalve S,Ellwanger A,Montedonico S.White blood cell count and C-reactive protein together remain useful for diagnosis and staging of acute appendicitis in children[J].S Afr Med J,2017,107(9):773-776.
[14] Gorter RR,Wassenaar ECE,Boer OJ,et al.Composition of the cellular infiltrate in patients with simple and complex appendicitis[J].J Surg Res,2017,214:190-196.
[15] 柏居林,孙巨军.血清淀粉样蛋白A、降钙素原、C-反应蛋白及白细胞计数联合检测在儿童下呼吸道感染诊断中的应用价值[J].陕西医学杂志,2018,47(8):1075-1077.
[16] 蒋唯松,周与华,王义辉,等.血必净注射液对EICU脓毒症患者炎症应激反应和心肌功能的影响[J].陕西中医,2020,41(4):502-504,523.
[17] Cui W,Liu H,Ni H,et al.Diagnostic accuracy of procalcitonin for overall and complicated acute appendicitis in children:A meta-analysis[J].Ital J Pediatrics,2019,45(1):78.
[18] 石正峰,游志恒,席红卫.Toll样受体-4降钙素原C反应蛋白表达水平在儿童急性复杂性阑尾炎的诊断价值[J].中国药物与临床,2019,19(7):129-130.
[19] Kularatna M,Lauti M,Haran C,et al.Clinical prediction rules for appendicitis in adults: Which is best[J].World J Surg,2017,41(7):1769-1781.
[20] 韩 非,徐欠欠,赵建国,等.Alvarado评分与AIR评分在急性阑尾炎诊断中的价值比较[J].腹部外科,2019,32(6):451-453,464.

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备注/Memo

备注/Memo:
基金项目:陕西省重点研发计划项目(2017SF-220)
更新日期/Last Update: 2022-08-04