小儿阑尾炎评分联合高频超声对5岁以上儿童阑尾炎类型的判别价值研究  

Diagnostic value of combining pediatric appendicitis score with high-frequency ultrasound for appendicitis typing in children aged above 5 years

作　　者：郭宏溪 杨俊[1] 卞红强[1] 杨虎[1] 郭琴[1] 孙贝贝[1] Guo Hongxi;Yang Jun;Bian Hongqiang;Yang Hu;Guo Qin;Sun Beibei(Department of General Surgery,Wuhan Children's Hospital(Municipal Maternal&Child Healthcare Hospital),Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430015,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院(武汉市妇幼保健院)普外科,武汉430015

出　　处：《临床小儿外科杂志》2022年第9期859-865,共7页Journal of Clinical Pediatric Surgery

基　　金：武汉市卫生局科研项目(WG13B11)。

摘　　要：目的探讨小儿阑尾炎评分(pediatric appendicitis score,PAS)联合高频超声对5岁以上儿童阑尾炎类型的判别价值。方法以华中科技大学同济医学院附属武汉儿童医院普外科2018年1月至2020年12月收治的394例急性阑尾炎患儿为研究对象,其中男性270例,女性124例;年龄(8.94±2.28)岁。收集每例患儿的PAS,并对术前超声结果进行判读。根据术后病理结果将所有患儿分为单纯性阑尾炎组(113例)和非单纯性阑尾炎组(281例),比较两组患儿一般情况、PAS及超声征象,取其中有统计学意义的变量进行逐步Fisher判别分析以构建判别函数。通过自身检验、交叉检验评价判别函数的诊断效能。结果单因素分析显示,两组间共13个因素差异有统计学意义(P<0.05)。采用逐步判别分析筛选出PAS、阑尾壁层次不清、血液中白细胞计数、病程、阑尾周围积液、阑尾增粗、阑尾周围脂肪增厚共7个指标进入判别函数。自身检验及交叉验证的结果均显示,该函数判别阑尾炎类型的准确率为94.7%(373/394);检验组验证结果显示,该函数判别阑尾炎类型的准确率为94.4%(84/89)。判别方程式:单纯性阑尾炎组为Y_(1)=-14.446-1.312X_(3)+1.102X_(5)+0.481X_(2)+0.065X_(1)-1.884X_(6)+4.046X_(4)+3.878X_(7),非单纯性阑尾炎组为Y_(2)=-36.834+1.509X_(3)+4.297X_(5)+0.687X_(2)+0.110X_(1)-0.167X_(6)+3.432X_(4)+0.874X_(7)。结论PAS联合高频超声有助于判别5岁以上儿童阑尾炎类型,进而指导临床医生制定合理的儿童急性阑尾炎治疗策略,具有一定的临床实用价值。Objective To explore the diagnostic value of combining pediatric appendicitis score(PAS)with high-frequency ultrasound for appendicitis types in children over 5 years of age.Methods Retrospective analysis was performed for 394 hospitalized appendicitis children fulfilling the inclusion criteria from JanuarY_(2)018 to December 2020.There were 270 boys and 124 girls with a mean age of(8.94±2.28)years.Depending on intraoperative finding and the final histology,patients were classified into two groups of simple appendicitis(n=113)and non-simple appendicitis(n=281).The effects of general data,PAS and ultrasonic images were compared between two groups.Fisher s stepwise discriminant analysis was employed for establishing a discriminant function by applying significant variables.Then the diagnostic efficacy of this model was verified by self-test,cross-validation and validation group.Results Univariate analysis indicated that 13 factors were statistically different between two group(P<0.05).Seven parameters of PAS,illegibility of wall layers,count of leucocyte,duration of symptoms,periappendiceal fluid,enlarged appendix and thickened periappendiceal fat were considered ultimately.The discriminant function equation was Y_(1)=-14.446-1.312X_(3)+1.102X_(5)+0.481X_(2)+0.065X_(1)-1.884X_(6)+4.046X_(4)+3.878X_(7),Y_(2)=-36.834+1.509X_(3)+4.297X_(5)+0.687X_(2)+0.110X_(1)-0.167X_(6)+3.432X_(4)+0.874X_(7).The results obtained by self-test and cross-validation all indicated that the accuracy rate of discriminant function was 94.7%(373/394);The results verified by validation group showed that the accuracy rate of discriminant function was 94.4%(84/89).Conclusion Combining PAS with high-frequency ultrasound is useful in distinguishing the types of appendicitis in children aged above 5 years.Thus clinicians may formulate reasonable treatments for acute appendicitis in children.

关 键 词：阑尾炎/诊断 超声检查 模型 统计学 判别分析 

分 类 号：R726.5[医药卫生—儿科]