白介素-6、降钙素原及C-反应蛋白对儿童急性阑尾炎伴穿孔的预测价值研究  

Predictive values of interleukin-6,procalcitonin and C-reactive protein in acute appendicitis with perforation in children

作　　者：张林[1] 张聪[1] 李勇[2] 尹强[2] 黄彩芝[1] 余翠花 Zhang Lin;Zhang Cong;Li Yong;Yin Qiang;Huang Caizhi;Yu Cuihua(Department of Clinical Laboratory,Hunan Children’s Hospital,Changsha 410007,Hunan,China;Department of Pediatric Surgery,Hunan Children’s Hospital,Changsha 410007,Hunan,China;Department of Pharmacy,The Third Hospital of Changsha,Changsha 410007,Hunan,China)

机构地区：[1]湖南省儿童医院检验中心 [2]湖南省儿童医院普外科,湖南省长沙市410007 [3]长沙市第三医院,湖南省长沙市410007

出　　处：《临床小儿外科杂志》2021年第8期749-753,共5页Journal of Clinical Pediatric Surgery

摘　　要：目的探讨白细胞介素-6(interleukin-6,IL-6)、降钙素原(procalcitonin,PCT)及C-反应蛋白(C-reactive protein,CRP)对儿童急性阑尾炎(acute appendicitis,AA)伴穿孔的预测价值。方法以2020年1月1日至2020年12月31日湖南省儿童医院和长沙市第三医院诊断为急性阑尾炎的307例患者作为研究对象,根据是否发生阑尾穿孔分为穿孔组(n=124)和未穿孔组(n=83),比较两组IL-6、PCT、CRP、白细胞计数(white blood cell,WBC)、中性粒细胞比值(neutrophil ratio%,N%)等指标。并根据受试者特征曲线(ROC curve,ROC)判断各指标诊断AA发生穿孔的效能。结果两组患者年龄、性别比例、白细胞计数、中性粒细胞比值差异无统计学意义(P>0.05)。穿孔组IL-6、PCT及CRP水平高于未穿孔组,差异有统计学意义(P<0.05)。对于判断AA发生穿孔,IL-6的灵敏度、特异度及ROC曲线下面积分别为75.3%、78.2%和0.777;PCT的灵敏度、特异度及ROC曲线下面积分别为54.7%、80.0%和0.684;CRP的灵敏度、特异度及ROC曲线下面积分别62.9%、82.5%和0.752。多因素Logistic回归分析提示:IL-6>36.6 pg/mL(OR=3.869,95%CI:1.025~14.597)及CRP>57.9 mg/L(OR=4.742,95%CI:1.248~18.013)是预测AA发生穿孔的独立危险因素(P<0.05)。IL-6及CRP联合检测并不优于其单独检测时的诊断效能(P>0.05)。结论IL-6、PCT及CRP对于判断急性阑尾炎是否发生穿孔有一定临床价值,IL-6诊断效能优于PCT及CRP;IL-6>36.6 pg/mL及CRP>57.9 mg/L可独立预测急性阑尾炎伴发穿孔的可能。Objective To explore the predictive values of interleukin-6(IL-6),procalcitonin(PCT)and C-reactive protein(CRP)in acute appendicitis(AA)with perforation in children.Methods From January 1 to December 31,2020,clinical data were reviewed retrospectively for 307 hospitalized AA children aged under 18 years at Hunan Children’s Hospital and The Third Hospital of Changsha.Based upon pathological examinations and intraoperative findings,they were divided into two groups of perforation(n=224)and non-perforation(n=83).The levels of IL-6,PCT,CRP,white blood cell(WBC)and neutrophil ratio(n%)were compared between two groups.The diagnostic performance of each parameter was judged by the receiver operating characteristic(ROC).Results No significant inter-group differences existed in age,gender ratio,WBC count or n%(P>0.05).The levels of IL-6,PCT and CRP were higher in perforation group than those in non-perforation group(P<0.05).The sensitivity,specificity and AUC(area under the ROC curve)of IL-6 for diagnosing perforation in AA were 75.3%,78.2%,0.777;the sensitivity,specificity and AUC of PCT 54.7%,80.0%,0.684;the sensitivity,specificity and AUC of CRP 62.9%,82.5%,0.752 respectively.Multiple Logistic regression revealed that IL-6>36.6 pg/mL(OR=3.869,95%CI:1.025-14.597)and CRP>57.9 mg/L(OR=4.742,95%CI:1.248-18.013)could independently predict whether or not AA was accompanied with perforation(P<0.05).Combination of IL-6 and CRP was not superior to single test of each parameter in diagnosing perforation in AA(P>0.05)Conclusion IL-6,PCT and CRP may play a role in discriminating whether or not AA is accompanied with perforation.The diagnostic performance of IL-6 is better than that of PCT/CRP.And IL-6>36.6 pg/mL and CRP>57.9 mg/L may independently predict perforation in AA.

关 键 词：阑尾炎/诊断 白介素-6 降钙素原 C-反应蛋白 儿童 

分 类 号：R574.61[医药卫生—消化系统] R726[医药卫生—内科学]