摘要
目的探讨C反应蛋白(CRP)及白细胞计数、中性粒细胞分数等炎性指标诊断阑尾炎穿孔的价值。方法选取2012—2015年在宁波大学医学院附属鄞州医院术前诊断为急性阑尾炎(含慢性阑尾炎急性发作)行阑尾手术(含腹腔镜阑尾切除术)患者862例。根据阑尾炎是否穿孔分为穿孔组(146例)和未穿孔组(716例)。收集患者术前同一时间点CRP、白细胞计数、中性粒细胞分数,绘制受试者工作特征(ROC)曲线,判断其诊断阑尾炎穿孔的价值。结果穿孔组和未穿孔组白细胞计数、中性粒细胞分数比较,差异均无统计学意义(P>0.05)。穿孔组CRP水平高于未穿孔组(P<0.05)。CRP>50 mg/L时,诊断阑尾炎穿孔的灵敏度是78.8%,特异度是90.9%。穿孔组与未穿孔组老年人和中青年人CRP水平比较,差异均有统计学意义(P<0.05)。CRP>25 mg/L时,诊断老年人阑尾炎穿孔的灵敏度是82.4%,特异度是81.0%。CRP>50 mg/L时,诊断中青年人阑尾炎穿孔的灵敏度是80.2%,特异度是89.7%。结论白细胞计数、中性粒细胞分数在术前无法准确诊断阑尾炎是否穿孔,但CRP可作为诊断急性阑尾炎是否穿孔的指标,并且诊断价值在中青年患者中较老年患者强。
Objective To investigate the value of inflammatory biomarkers such as C reactive protein（CRP） and white blood cell count,neutrophil percentage for the preoperative diagnosis of perforated appendicitis.Methods The participants enrolled were 862 with acute appendicitis（acute attack of chronic appendicitis was included） diagnosed preoperatively and treated by appendectomy（laparoscopic appendectomy was covered） in Yinzhou Hospital Affiliated to Medical School of Ningbo University from 2012 to 2015.Based on the severity of appendicitis,they were divided into perforated group（146 cases） and non-perforated group（716 cases）.The data of preoperative CRP,white blood cell count and neutrophil percentage of the participants measured at the same time were collected.The receiver operating characteristic（ROC） curve of the above three biomarkers were drawn for assessing their performance in the diagnosis of perforated appendicitis.Results The white blood cell count and neutrophil percentage did not differ significantly between the groups（P〉0.05）.Perforated group had higher CRP than the non-perforated group did（P〈0.05）.When CRP was greater than 50 mg/L,it provided a sensitivity of 78.8%,and specificity of 90.9% for diagnosing perforated appendicitis.The young and middle-aged in the perforated group had higher CRP levels than those in the non-perforated group（P〈0.05）.Higher CRP levels were found in the elderly in the perforated group than in those in the non-perforated group（P〈0.05）.When CRP was greater than 25 mg/L,it provided a sensitivity of 82.4%,and specificity of 81.0% for diagnosing perforated appendicitis in the elderly;when it was over 50 mg/L,its sensitivity and specificity was respectively 80.2% and 89.7% for the diagnosis of perforated appendicitis in the young and middle-aged.Conclusion White blood cell count and neutrophil percentage cannot accurately predict perforated appendicitis preoperatively,but CRP can be used as a predictor for acute appendicitis accompanied by perforation,and its diagnostic performance is better for the young and middle-aged than the elderly.
出处
《中国全科医学》
CAS
北大核心
2017年第17期2139-2142,共4页
Chinese General Practice
关键词
阑尾炎
阑尾炎穿孔
C反应蛋白质
白细胞计数
Appendicitis
Perforated appendicitis
C-reactive protein
Leukocyte count
