Xu Yongkang,Yun Ye,Zhao Yongxiang,et al.Applicable value of serum c-reactive protein,interleukin 6 and procalcitonin in acute complex pediatric appendicitis[J].Journal of Clinical Pediatric Surgery,,20():60-64.[doi:10.12260/lcxewkzz.2021.01.012]
Applicable value of serum c-reactive protein,interleukin 6 and procalcitonin in acute complex pediatric appendicitis
- Keywords:
- Appendicitis/DI; Appendicitis/IM; C-Reactive Protein; Interleukin 6; Procalcitonin; Child
- CLC:
- R726;R574.61
- Abstract:
- Objective To explore the correlation between serum C-reactive protein (CRP),interleukin-6 (IL-6),procalcitonin (PCT) and acute complex appendicitis in children and examine their diagnostic values.Methods A total of 96 hospitalized children with acute appendicitis underwent operations from 2016 to 2017.They were divided into two groups of simple appendicitis (n=30,A1) and complex suppurative/gangrenous appendicitis (n=60,A2).The preoperative serum concentrations of CRP,IL-6,and PCT were measured and compared for two groups.The receiver operating characteristic (ROC) curves were plotted for analyzing the diagnostic values of CRP,IL-6 and PCT in children with acute complex appendicitis.Results No statistical significance existed in age,gender or weight between two groups (P>0.05).The levels of CRP,IL-6 and PCT were significantly higher in group A2 than those in group A1 (P<0.05).ROC curve was plotted according to the postoperative pathological results for analyzing the diagnostic efficiency of CRP,PCT and IL-6 for complicated appendicitis.AUC of CRP,PCT,IL-6 and their combined test were 0.906(95%CI:0.829-0.956),0.953(95%CI:0.889-0.986),0.765(95%CI:0.668-0.846) and 0.973(95%CI:0.971-0.995) respectively.Value of AUC was PCT+CRP+IL-6 > PCT > CRP > IL-6.AUC of combined test was statistically different from that of CRP/IL-6 (Z=2.932,P=0.003;Z=3.854,P=0.0001).No statistical difference existed between AUC of combined test and that of PCT (Z=1.861,P=0.063) or between AUC of CRP and that of PCT (Z=1.668,P=0.095);and statistical difference existed between AUC of IL-6 and that of CRP/PCT (Z=2.312,P=0.021;Z=3.371,P=0.001).The obtained optimal critical points were 11.47(95%CI:11.42-14.48) mg/L,0.87(95%CI:0.63-0.98) ng/L and 88.60(95%CI:87.12-170.83) pg/ml respectively.Conclusion Clinicians can judge the severity of appendicitis during an early stage by CRP,IL-6 and PCT so as to win the cooperation of parents,perform operations as early as possible and reduce the occurrence of complications.
References:
1 张金哲.小儿腹部外科学(第1版)[M].杭州:浙江科学技术出版社,2008.Zhang JZ.Editor-in-Chief,Pediatric Abdominal Surgery (First Edition)[M].Hangzhou:Zhejiang Science and Technology Publishing House,2008.
2 Acharya A,Markar SR,Ni M,et al.Biomarkers of acute appendicitis:systematic review and cost-benefit trade-off analysis[J].Surg Endosc,2017,31(3):1022-1031.DOI:10.1007/s00464-016-5109-1.
3 徐长胜.腹腔镜手术治疗急性穿孔性阑尾炎的临床疗效及对血清 C 反应蛋白和降钙素原水平的影响[J].临床医学研究与实践,2017,2(23):44-45.DOI:10.19347/j.cnki.2096-1413.201723021.Xu CS.Clinical efficacy of laparoscopy for acute perforating appendicitis and its effect on serum levels of C-reactive protein and procalcitonin[J].Clinical Research and Practice,2017,2(23):44-45.DOI:10.19347/j.cnki.2096-1413.201723021.
4 孔燕军,陈颖,赵华头.C-反应蛋白在急诊中鉴别小儿肠系膜淋巴结炎与急性阑尾炎中的意义[J].中国美容医学,2012,21(10):37-38.DOI:10.3969/j.issn.1008-6455.2012.10.028.Kong YJ,Chen Y,Zhao HT.Role of C-reactive protein in the differential diagnosis of acute mesenteric lymphadenitis and acute appendicitis in children in emergency settings[J].China Aesthetic Medicine,2012,21(10):37-38.DOI:10.3969/j.issn.1008-6455.2012.10.028.
5 黄爱芳.超敏C反应蛋白、白细胞计数联合检测对诊断小儿急性阑尾炎的临床意义[J].检验医学与临床,2012,9(20):2620-2621.DOI:10.3969/j.issn.1672-9455.2012.20.052.Huang AF.Clinical significance of combined detection of high-sensitivity C-reactive protein and white blood cell count in the diagnosis of acute appendicitis in children[J].Laboratory Medicine and Clinical,2012,9(20):2620-2621.DOI:10.3969/j.issn.1672-9455.2012.20.052.
6 周兵.急性阑尾炎患者行 D-二聚体,降钙素原和C反应蛋白诊断的价值[J].深圳中西医结合杂志,2017,27(5):79-80.DOI:10.16458/j.cnki.1007-0893.2017.05.038.Zhou B.Diagnostic values of D-dimer,procalcitonin and C-reactive protein in patients with acute appendicitis[J].Shenzhen Journal of Integrated Traditional Chinese and Western Medicine,2017,27 (5):79-80.DOI:10.16458/j.cnki.1007-0893.2017.05.038.
7 方红伟,李峰.血清降钙素原,超敏C反应蛋白以及白细胞介素 6 在小儿急性上呼吸道感染中的临床诊断价值[J].新疆医学,2014,44 (6):16-18.Fang HW,Li F.Clinical diagnostic value of serum procalcitonin,hypersensitive C-reactive protein and interleukin-6 in children with acute upper respiratory tract infection[J].Xinjiang Medical Science,2014,44 (6):16-18.
8 朱秋良.D-二聚体,降钙素原和C反应蛋白在急性阑尾炎中的评价[J].国际检验医学杂志,2013,34(17):2248-2249.DOI:10.3969/j.issn.1673-4130.2013.17.017.Zhu QL.Evaluations of D-dimer,procalcitonin and C-reactive protein in acute appendicitis[J].International Journal of Laboratory Medicine,2013,34(17):2248-2249.DOI:10.3969/j.issn.1673-4130.2013.17.017.
9 Blab E,Kohlhuber U,Tillawi S,et al.Advancements in the diagnosis of acute appendicitis in children and adolescents[J] .Eur J Pediatr Surg,2004,14(6):404-409.DOI:10.1055/s-2004-821152.
10 张菊嫦.阑尾对肠道微生物影响的研究[D].南方医科大学,2017.DOI:10.7666/d.Y3280759.Zhang JC.Effects of appendix on gut microbiota[D].Southern Medical University,2017.DOI:10.7666/d.Y3280759.
11 张甜.实时监测血清降钙素原水平在小儿急性阑尾炎诊治中的应用价值[J].医学临床研究,2017,34(4):749-751.DOI:10.3969/j.issn.1671-7171.2017.04.042.Zhang T.Application value of real-time monitoring serum level of procalcitonin in the diagnosis and treatment of acute appendicitis in children[J].Medical Clinical Study,2017,34(4):749-751.DOI:10.3969/j.issn.1671-7171.2017.04.042.
12 张曼丽.尿常规检验用于诊断小儿急性阑尾炎的临床观察[J].中国急救医学,2016,36(1):6-7.DOI:10.3969/j.issn.1002-1949.2016.z1.005.Zhang ML.Clinical observation of urinary routine examination for diagnosing acute appendicitis in children[J].China Emergency Medicine,2016,36(1):6-7.DOI:10.3969 /j.issn.1002-1949.2016.z1.005.
13 Tanr?kulu C?, Karamercan MA,Tanr?kulu Y,et al.The predictive value of Alvarado score,inflammatory parameters and ultrasound imaging in the diagnosis of acute appendicitis[J].Ulusal cerrahi dergisi,2015,32(2):115-121.DOI:10.5152/UCD.2015.3103.
14 Acharya A,Markar SR,Ni M,et al.Biomarkers of acute appendicitis:systematic review and cost-benefit trade-off analysis[J].Surgical endoscopy,2017,31(3):1022-1031.DOI:10.1007/s00464-016-5109-1.
15 Hackam DJ,Afrazi A,Good M,et al.Innate immune signaling in the pathogenesis of necrotizing enterocolitis[J].Clin Dev Immunol,2013,54(32):2015-2025.DOI:10.1155/2013/475415.
16 Yu CW,Juan LI,Wu MH,et al.Systematic review and meta-analysis of the diagnostic accuracy of procalcitonin,C-reactive protein and white blood cell count for suspected acute appendicitis[J].Br J Surg,2013,100(3):322-329.DOI:10.1002/bjs.9008.
Memo
收稿日期:2019-03-18。
基金项目:包头市社会发展科技支撑项目(编号:2017S2001-6-1)
通讯作者:赵永祥,Email:121418388@qq.com;姜海山,Email:584955375@qq.com