摘要
目的探讨术前C反应蛋白(CRP)与血清蛋白电泳检测在儿童穿孔性阑尾炎中的诊断价值。方法收集天津市儿童医院微创外科2019年3月1日至2019年9月15日符合纳入标准的急性阑尾炎患儿243例,根据术后病理分为非穿孔性阑尾炎组(160例)和穿孔性阑尾炎组(83例)。采用单因素分析2组患儿基本资料、血清蛋白电泳及血常规等指标的相关性,将单因素中有统计学意义的指标纳入二分类Logistic多因素回归分析,筛选出可协助诊断小儿穿孔性阑尾炎的指标。然后,采用Logistic回归对纳入的指标建立回归方程,对新变量Y及纳入的指标进行受试者工作特征曲线(ROC曲线)分析。最后,通过ROC曲线的比较,探讨新变量及纳入的指标对穿孔性阑尾炎的诊断价值。结果多因素Logistic回归分析结果显示,CRP(OR=1.010,95%CI:1.003~1.017)、血清α1球蛋白(OR=2.340,95%CI:1.465~3.738)是儿童穿孔性阑尾炎的独立危险因素。ROC曲线分析结果显示,新变量Y的曲线下面积为0.845,约登指数最高,为0.564。但通过ROC曲线的比较,两指标联合诊断价值与CRP单独诊断价值差异无统计学意义(P>0.05),两指标联合诊断价值与α1球蛋白单独诊断价值比较,差异有统计学意义(P<0.05),CRP与α1球蛋白ROC曲线下面积差值为0.011,两者诊断价值差异无统计学意义(P>0.05),尚不能说明两指标的诊断价值存在差异。结论CRP与血清蛋白电泳中的α1球蛋白对小儿穿孔性阑尾炎均有较好的预测价值,可作为选择是否手术的参考指标,且两者的诊断价值无明显差异。CRP与α1球蛋白联合诊断的价值与CRP单独诊断相比,无明显差异,但较α1球蛋白单独诊断的价值高。
Objective To explore the diagnostic value of preoperative C-reactive protein(CRP)and serum protein electrophoresis in children with perforated appendicitis.Methods From March 1,2019 to September 15,2019,243 children with acute appendicitis who met the inclusion criteria in Department of minimally invasive surgery of Tianjin Children′s Hospital were collected.According to the postoperative pathology,they were divided into non perforation group(160 cases)and perforation group(83 cases).Through the single factor analysis of the correlation between the basic data,serum protein electrophoresis and blood routine of the two groups of children,the indexes with statistical significance in the single factor were included in the binary Logistic multivariate regression analysis,and the indexes that could help to diagnose children′s perforated appendicitis were screened out.Then,Logistic regression was used to establish regression equation for the included indexes,and ROC curve was used to analyze the new variable Y and the included indexes.Finally,through the ROC curve comparison,to explore the new variables and indicators included in the diagnosis of perforated appendicitis.Results Multivariate Logistic regression analysis showed that CRP(OR=1.010,95%CI:1.003-1.017)and serumα1 globulin(OR=2.340,95%CI:1.465-3.738)were independent risk factors for children with perforated appendicitis.ROC curve analysis showed that the area under the curve of new variable Y was 0.845,and the highest Yordan index was 0.564.However,through the ROC curve comparison,there is no statistical significance between CRP combined withα1 globulin and CRP alone(P>0.05).There were statistical significance between CRP combined withα1 globulin andα1 globulin alone(P<0.05).The area difference under the ROC curve between CRP andα1 globulin was 0.011;the difference was statistical significance between CRP andα1 globulin(P>0.05),which could not explain the difference between the two indexes.Conclusion CRP andα1 globulin in serum protein electrophoresis have good predictive value for children′s perforated appendicitis,which can be used as a reference index to choose whether to operate,and there is no significant difference in the diagnostic value between the two.There is no significant difference between the diagnostic value of CRP combined withα1 globulin and that of CRP alone,but it is higher than that ofα1 globulin alone.
作者
王鑫慧
董亮
WANG Xinhui;DONG Liang(Graduate School of Tianjin Medical University,Tianjin 300070,China;Department of Minimally Invasive Surgery,Tianjin Children′s Hospital,Tianjin 300134,China)
出处
《检验医学与临床》
CAS
2020年第15期2192-2195,2198,共5页
Laboratory Medicine and Clinic
