Ding Zhili,Bao Jingfeng,Sun Hailiang,et al.Diagnostic value of Alvarado score,C-reactive protein,neutrophil lymphocyte ratio in children with perforated appendicitis[J].Journal of Clinical Pediatric Surgery,2023,22(11):1060-1064.[doi:10.3760/cma.j.cn101785-202201022-011]
Alvarado评分与C反应蛋白、中性粒细胞淋巴细胞比值对小儿穿孔性阑尾炎诊断价值的研究
- Title:
- Diagnostic value of Alvarado score,C-reactive protein,neutrophil lymphocyte ratio in children with perforated appendicitis
- Keywords:
- Appendicitis; Diagnosis; C-Reactive Protein; Lymphocytes; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨Alvarado评分(Alvarado score,AS)与C反应蛋白(C-reactive protein,CRP)、中性粒细胞淋巴细胞比值(neutrophil lymphocyte ratio,NLR)对小儿穿孔性阑尾炎中的诊断价值。方法 本研究为回顾性研究,以2018年9月至2020年9月在南通大学附属常州儿童医院就诊的120例小儿急性阑尾炎患者为研究对象,根据病理结果分为穿孔组(n=60)和非穿孔组(n=60)。比较两组患儿性别、年龄、AS、CRP以及NLR的差异;通过回归分析筛选出可协助诊断穿孔性阑尾炎的指标,然后采用受试者工作特征(receiver operating characteristic,ROC)曲线进行分析,评估相关指标在小儿穿孔性阑尾炎中的诊断价值。结果 多因素分析结果显示,AS高(OR=2.899,95%CI:1.704~4.930)以及CRP(OR=1.130,95%CI:1.002~1.025)、NLR(OR=1.130,95%CI:1.040~1.227)水平升高是穿孔性阑尾炎的独立危险因素;AS、CRP、NLR判断穿孔性阑尾炎的ROC曲线下面积分别是0.873(95%CI:0.812~0.934)、0.765(95%CI:0.683~0.848)、0.763(95%CI:0.679~0.847),临界值分别为7.5、60.9、15.7;AS联合CRP、AS联合NLR、AS联合CRP及NLR判断穿孔性阑尾炎的ROC曲线下面积分别是0.897(95%CI:0.844~0.950)、0.904(95%CI:0.852~0.956)、0.911(95%CI:0.873~0.967)。结论 AS＞7.5、CRP＞60.9 ng/mL、NLR＞15.7对诊断患儿发生穿孔性阑尾炎有较好的应用价值,可尽早识别阑尾炎的严重程度。
- Abstract:
- Objective To explore the diagnostic value of Alvarado score (AS),C-reactive protein (CRP) and neutrophil lymphocyte ratio (NLR) in children with perforated appendicitis (PA).Methods For this retrospective study,120 children hospitalized with acute appendicitis from September 2018 to September 2020 were selected.According to the pathological results,they were assigned into two groups of perforated (n=60) and non-perforated (n=60).The inter-group differences of gender,age,AS,CRP and NLR were examined.The relevant parameters assisting in the diagnosis of PA were screened by regression analysis.And receiver operating characteristic (ROC) curve was utilized for predicting the diagnostic value of relevant parameters in PA children.Results Logistic regression analysis indicated that AS(OR=2.899,95%CI:1.704~4.930),CRP(OR=1.130,95%CI:1.002~1.025) and NLR(OR=1.130,95%CI:1.040~1.227) were the independent risk factors of PA.The areas under the ROC curve of AS,CRP and NLR were 0.873(95%CI:0.812~0.934),0.765(95%CI:0.683~0.848) and 0.763(95%CI:0.679~0.847); The areas under the ROC curve of AS plus CRP,AS plus NLR and AS plus CRP/NLR were 0.897(95%CI:0.844~0.950),0.904(95%CI:0.852~0.956) and 0.911(95%CI:0.873~0.967).Conclusions AS ＞7.5,CRP＞60.9 ng/mL and NLR＞15.7 offer decent predictive values in the diagnosis of PA in children.It may gauge the severity of appendicitis in an early stage.
参考文献/References:
[1] 张妮妮,江逊.小儿急性阑尾炎的临床及诊治进展[J].临床小儿外科杂志,2020,19(11):1042-1046.DOI:10.3969/j.issn.1671-6353.2020.11.016. Zhang NN,Jiang X.Recent advances in clinical diagnosis and treatment of acute appendicitis in children[J].J Clin Ped Sur,2020,19(11):1042-1046.DOI:10.3969/j.issn.1671-6353.2020.11.016.
[2] Kalan M,Talbot D,Cunliffe WJ,et al.Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis:a prospective study[J].Ann R Coll Surg Engl,1994,76(6):418-419.
[3] Maita S,Andersson B,Svensson JF,et al.Nonoperative treatment for nonperforated appendicitis in children:a systematic review and meta-analysis[J].Pediatr Surg Int,2020,36(3):261-269.DOI:10.1007/s00383-019-04610-1.
[4] Davis J,Kasmire K.Utility of symptom duration and C-reactive protein,white blood cell count,and absolute neutrophil count in the evaluation of pediatric appendicitis[J].J Emerg Med,2021,60(4):428-435.DOI:10.1016/j.jemermed.2020.10.040.
[5] 张林,张聪,李勇,等.白介素-6、降钙素原及C-反应蛋白对儿童急性阑尾炎伴穿孔的预测价值研究[J].临床小儿外科杂志,2021,20(8):749-753.DOI:10.3969/j.issn.1671-6353.2021.08.009. Zhang L,Zhang C,Li Y,et al.Predictive values of interleukin-6,procalcitonin and C-reactive protein in acute appendicitis with perforation in children[J].J Clin Ped Sur,2021,20(8):749-753.DOI:10.3969/j.issn.1671-6353.2021.08.009.
[6] 徐永康,云叶,赵永祥,等.血清C反应蛋白、白介素-6和降钙素原对小儿急性复杂性阑尾炎的诊断价值研究[J].临床小儿外科杂志,2021,20(1):60-64.DOI:10.12260/lcxewkzz.2021.01.012. Xu YK,Yun Y,Zhao YX,et al.Application values of serum C-reactive protein,interleukin 6 and procalcitonin in acute complex appendicitis in children[J].J Clin Ped Sur,2021,20(1):60-64.DOI:10.12260/lcxewkzz.2021.01.012.
[7] Qi XS,Li JJ,Deng H,et al.Neutrophil-to-lymphocyte ratio for the prognostic assessment of hepatocellular carcinoma:a systematic review and meta-analysis of observational studies[J].Oncotarget,2016,7(29):45283-45301.DOI:10.18632/oncotarget.9942.
[8] Pantzaris ND,Platanaki C,Pierrako C,et al.Neutrophil-to-lymphocyte ratio relation to sepsis severity scores and inflammatory biomarkers in patients with community-acquired pneumonia:a case series[J].J Transl Int Med,2018,6(1):43-46.DOI:10.2478/jtim-2018-0009.
[9] Nazik S,Avci V,Küskü Kiraz Z.Ischemia-modified albumin and other inflammatory markers in the diagnosis of appendicitis in children[J].Ulus Travma Acil Cerrahi Derg,2017,23(4):317-321.DOI:10.5505/tjtes.2016.11823.
[10] Eun S,Ho IG,Bae GE,et al.Neutrophil-to-lymphocyte ratio for the diagnosis of pediatric acute appendicitis:a systematic review and meta-analysis[J].Eur Rev Med Pharmacol Sci,2021,25(22):7097-7107.DOI:10.26355/eurrev_202111_27263.
[11] Kahramanca S,Ozgehan G,Seker D,et al.Neutrophil-to-lymphocyte ratio as a predictor of acute appendicitis[J].Ulus Travma Acil Cerrahi Derg,2014,20(1):19-22.DOI:10.5505/tjtes.2014.20688.
[12] Yazar FM,Urfalioglu A,Bakacak M,et al.Efficacy of the evaluation of inflammatory markers for the reduction of negative appendectomy rates[J].Indian J Surg,2018,80(1):61-67.DOI:10.1007/s12262-016-1558-y.
[13] Delgado-Miguel C,Mu?oz-Serrano AJ,Barrena Delfa S,et al.Neutrophil-to-lymphocyte ratio as a predictor of peritonitis in acute appendicitis in children[J].Cir Pediatr,2019,32(4):185-189.
[14] Alvarado A.A practical score for the early diagnosis of acute appendicitis[J].Ann Emerg Med,1986,15(5):557-564.DOI:10.1016/s0196-0644(86)80993-3.
[15] Al Awayshih MM,Nofal MN,Yousef AJ.Evaluation of Alvarado score in diagnosing acute appendicitis[J].Pan Afr Med J,2019,34:15.DOI:10.11604/pamj.2019.34.15.17803.
[16] do Nascimento RR,Souza JCG,Alexandre VB,et al.Association between the Alvarado score and surgical and histopathological findings in acute appendicitis[J].Rev Col Bras Cir,2018,45(5):e1901.DOI:10.1590/0100-6991e-20181901.
相似文献/References:
[1]饶品德,陈勇.阑尾炎术后急性肾功能衰竭2例报道[J].临床小儿外科杂志,2010,9(06):473.
[2]陆良生阮双岁毕允力陆毅群王翔葛琳娟肖现民.45例两性畸形患儿的诊断及治疗分析[J].临床小儿外科杂志,2011,10(01):0.
[3]谷奇,邹继珍,叶辉,等.促纤维增生性小圆细胞肿瘤诊治体会[J].临床小儿外科杂志,2008,7(01):32.
[4]孙颖华,郑珊,钱蔷英,等.超声检查在胆道闭锁鉴别诊断中的运用价值[J].临床小儿外科杂志,2008,7(04):0.
[5]何炜婧,郑珊,沈淳,等.新生儿腹膜后占位性病变诊治分析[J].临床小儿外科杂志,2008,7(06):5.
[6]张颖,李洪秋,赵群,等.儿童骨嗜酸细胞性肉芽肿的诊断与治疗[J].临床小儿外科杂志,2007,6(01):23.
[7]蒋跃先.845例小儿急性肠套叠诊治体会[J].临床小儿外科杂志,2007,6(02):30.
[8]蒋宏 陈华东 张志崇 潘静 刘钧澄.3例婴儿腹腔巨大积水的诊治体会[J].临床小儿外科杂志,2011,10(03):231.
[J].Journal of Clinical Pediatric Surgery,2011,10(11):231.
[9]张生 金先庆 李晓庆 周德凯 向丽 刘伟. 先天性肠闭锁、肠狭窄120例临床分析[J].临床小儿外科杂志,2011,10(04):273.
[J].Journal of Clinical Pediatric Surgery,2011,10(11):273.
[10]张振强高群黄河陈晨张燕敏赛恺. 儿童阑尾脓肿的腹腔镜治疗[J].临床小儿外科杂志,2011,10(04):286.
[J].Journal of Clinical Pediatric Surgery,2011,10(11):286.
[11]刘娜,王怀杰,姜珏,等.应用ＲＯＣ评价Ａｌｖａｒａｄｏ改良评分联合高频超声回盲部定位法对小儿不同病理分型阑尾炎的诊断价值[J].临床小儿外科杂志,2017,16(06):564.
备注/Memo
收稿日期:2022-1-11。
基金项目:常州市卫健委科技项目(WZ202219)
通讯作者:汤强,Email:zchcunt@163.com