Alvarado评分和超声检查鉴别诊断小儿急性阑尾炎和急性肠系膜淋巴结炎的准确性研究  

Clinical Differentiation between Acute Appendicitis and Acute Mesenteric Lymphadenitis Using Alvarado Score and Ultrasonagraphy

作　　者：田晖[1] 王文刚[1] 闫记英[1] 剧红娟[1] 张彤迪[1] 赵雅培[1] 李涛[1] 张丽艳[1] 

机构地区：[1]河北医科大学第二医院超声科,河北省石家庄市050000

出　　处：《中国全科医学》2013年第20期2392-2394,共3页Chinese General Practice

基　　金：河北省科技厅科技攻关项目(06276102D-98)

摘　　要：目的探讨Alvarado评分和超声检查在小儿急性阑尾炎和小儿急性肠系膜淋巴结炎鉴别诊断中的临床价值。方法选取2011年1月—2012年8月因腹痛来我院就诊的患儿202例,均在初诊时进行Alvarado评分及高频超声检查。急性阑尾炎诊断金标准为病理检查结果;急性肠系膜淋巴结炎根据病史、实验室检查、超声检查以及疗效随访确诊。比较急性阑尾炎和急性肠系膜淋巴结炎患儿的临床指标,并将Alvarado评分、超声检查结果与金标准进行比较,计算敏感度、特异度、准确度、阳性预测值、阴性预测值、阳性似然比、阴性似然比。结果急性阑尾炎患儿主诉恶心/呕吐、转移性右下腹痛者比例,右下腹压痛、反跳痛、腹部肌紧张者比例,白细胞计数、中性粒细胞分数均高于急性肠系膜淋巴结炎患儿,两组比较差异有统计学意义(P<0.05)。Alvarado评分>6分诊断急性阑尾炎的敏感度、特异度、准确度、阳性预测值、阴性预测值、阳性似然比、阴性似然比分别为79.3%、66.1%、71.8%、63.9%、80.9%、2.3、0.3,高频超声诊断急性阑尾炎的上述指标分别为90.7%、89.8%、90.3%、92.9%、86.9%、8.9、0.1。Alvarado评分≤6分诊断急性肠系膜淋巴结炎的准确度为64.4%,高频超声诊断的准确度为90.3%。结论 Al-varado评分结合超声检查能够较准确地诊断、鉴别小儿急性阑尾炎和急性肠系膜淋巴结炎。Objective To evaluate the clinical value of Alvarado score and ultrasonagraphy in differentiating the acute appendicitis（AA） and acute mesenteric lymphadenitis（AML）.Methods A total of 202 children who visited our hospital with a complaint of acute abdominal pain between January 2011 and August 2012 were included in the study.All of them were measured using Alvarado score and high frequency ultrasonography at the first visit.The gold standard of diagnosing AA is pathological examination results,while the diagnosis of AML was made according to medical history,clinical laboratory examination results,ultrasonic examination results,and follow-up results.The clinical indicators of AA and AML were compared.Alvarado scores and ultrasonic examination results were compared with the gold standards.The sensitivity,specificity,accuracy,positive predictive value,negative predictive value,positive likelihood ratio,and negative likelihood ratio were calculated.Results The rates of complaints of nausea / vomiting and migrant right lower quadrant（RLQ） pain,complaints of RLQ tenderness,rebound tenderness,and abdominal muscle tension,and counts of while blood cell and leukocytes were higher in AA group than in AML group（P〈 0.05）.The sensitivity,specificity,accuracy,positive predictive value,negative predictive value,positive likelihood ratio,and negative likelihood ratio of AA diagnosis by Alvarado score 6 were 79.3%,66.1%,71.8%,63.9%,80.9%,2.3,and 0.3,and the parameters of AML diagnosis by high frequency ultrasonography were 90.7%,89.8%,90.3%,92.9%,86.9%,8.9,and 0.1.The accuracy of AML diagnosis was 64.4% by Alvarado score ≤6,and 90.3% by high frequency ultrasonography.Conclusion The combination of Alvarado score and high frequency ultrasound can distinguish between AA and AML with a high level of accuracy.

关 键 词：Alvarado评分 超声检查 阑尾炎 肠系膜淋巴腺炎 诊断 鉴别 

分 类 号：R725.746[医药卫生—儿科] R725.512.4[医药卫生—临床医学]