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  

Diagnostic and prognostic value of serological indexes combined with Alvarado score in children with complicated appendicitis

作　　者：高勇[1] 徐珂[1] GAO Yong;XU Ke(Department of Pediatric Surgery,Maternal and Child Health Hospital of Baoji,Baoji 721000,China)

机构地区：[1]宝鸡市妇幼保健院小儿外科,陕西宝鸡721000

出　　处：《陕西医学杂志》2022年第8期1016-1020,共5页Shaanxi Medical Journal

基　　金：陕西省重点研发计划项目(2017SF-220)。

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。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 childre

关 键 词：急性阑尾炎 复杂性阑尾炎 Alvarado评分 血清学 诊断 预后 

分 类 号：R726.5[医药卫生—儿科]