Guo Hongxi,Yang Jun,Bian Hongqiang,et al.Diagnostic value of combining pediatric appendicitis score with high-frequency ultrasound for appendicitis typing in children aged above 5 years[J].Journal of Clinical Pediatric Surgery,2022,21(09):859-865.[doi:10.3760/cma.j.cn101785-202107022-012]
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
- Title:
- Diagnostic value of combining pediatric appendicitis score with high-frequency ultrasound for appendicitis typing in children aged above 5 years
- Keywords:
- Appendicitis/DI; Ultrasonography; Models; Statistical; Discriminant Analysis
- 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Y1=-14.446-1.312X3+1.102X5+0.481X2+0.065X1-1.884X6+4.046X4+3.878X7，非单纯性阑尾炎组为Y2=-36.834+1.509X3+4.297X5+0.687X2+0.110X1-0.167X6+3.432X4+0.874X7。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。
- Abstract:
- 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 2018 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 Y1=-14.446-1.312X3+1.102X5+0.481X2+0.065X1-1.884X6+4.046X4+3.878X7, Y2=-36.834+1.509X3+4.297X5+0.687X2+0.110X1-0.167X6+3.432X4+0.874X7.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.
参考文献/References:
[1] Stringer MD.Acute appendicitis[J].J Paediatr Child Health, 2017, 53(11):1071-1076.DOI:10.1111/jpc.13737.
[2] Gorter RR, The S, Gorter-Stam M, et al.Systematic review of nonoperative versus operative treatment of uncomplicated appendicitis[J].J Pediatr Surg, 2017, 52(8):1219-1227.DOI:10.1016/j.jpedsurg.2017.04.005.
[3] Gorter RR, van der Lee JH, Heijsters F, et al.Outcome of initially nonoperative treatment for acute simple appendicitis in children[J].J Pediatr Surg, 2018, 53(9):1849-1854.DOI:10.1016/j.jpedsurg.2017.12.012.
[4] Podda M, Gerardi C, Cillara N, et al.Antibiotic treatment and appendectomy for uncomplicated acute appendicitis in adults and children:a systematic review and meta-analysis[J].Ann Surg, 2019, 270(6):1028-1040.DOI:10.1097/SLA.0000000000003225.
[5] 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.
[6] Tiboni S, Bhangu A, Hall NJ.Outcome of appendicectomy in children performed in paediatric surgery units compared with general surgery units[J].Br J Surg, 2014, 101(6):707-714.DOI:10.1002/bjs.9455.
[7] Girard-Madoux M, Gomez de Agüero M, Ganal-Vonarburg SC, et al.The immunological functions of the appendix:An example of redundancy?[J].Semin Immunol, 2018, 36:31-44.DOI:10.1016/j.smim.2018.02.005.
[8] Zani A, Teague WJ, Clarke SA, et al.Can common serum biomarkers predict complicated appendicitis in children?[J].Pediatr Surg Int, 2017, 33(7):799-805.DOI:10.1007/s00383-017-4088-1.
[9] Gudjonsdottir J, Marklund E, Hagander L, et al.Clinical prediction scores for pediatric appendicitis[J].Eur J Pediatr Surg, 2021, 31(3):252-260.DOI:10.1055/s-0040-1710534.
[10] Carpenter JL, Orth RC, Zhang W, et al.Diagnostic performance of US for differentiating perforated from nonperforated pediatric appendicitis:a prospective cohort study[J].Radiology, 2017, 282(3):835-841.DOI:10.1148/radiol.2016160175.
[11] Riedesel EL, Weber BC, Shore MW, et al.Diagnostic performance of standardized ultrasound protocol for detecting perforation in pediatric appendicitis[J].Pediatr Radiol, 2019, 49(13):1726-1734.DOI:10.1007/s00247-019-04475-5.
[12] Samuel M.Pediatric appendicitis score[J].J Pediatr Surg, 2002, 37(6):877-881.DOI:10.1053/jpsu.2002.32893.
[13] Rawolle T, Reismann M, Minderjahn MI, et al.Sonographic differentiation of complicated from uncomplicated appendicitis[J].Br J Radiol, 2019, 92(1099):20190102.DOI:10.1259/bjr.20190102.
[14] Atema JJ, van Rossem CC, Leeuwenburgh MM, et al.Scoring system to distinguish uncomplicated from complicated acute appendicitis[J].Br J Surg, 2015, 102(8):979-990.DOI:10.1002/bjs.9835.
[15] Fujii T, Tanaka A, Katami H, et al.Usefulness of the pediatric appendicitis score for assessing the severity of acute appendicitis in children[J].Pediatr Int, 2020, 62(1):70-73.DOI:10.1111/ped.14032.
[16] Hao TK, Chung NT, Huy HQ, et al.Combining ultrasound with a pediatric appendicitis score to distinguish complicated from uncomplicated appendicitis in a pediatric population[J].Acta Inform Med, 2020, 28(2):114-118.DOI:10.5455/aim.2020.28.114-118.
[17] Gonzalez DO, Lawrence AE, Cooper JN, et al.Can ultrasound reliably identify complicated appendicitis in children?[J].J Surg Res, 2018, 229:76-81.DOI:10.1016/j.jss.2018.03.012.
[18] Blumfield E, Yang D, Grossman J.Scoring system for differentiating perforated and non-perforated pediatric appendicitis[J].Emerg Radiol, 2017, 24(5):547-554.DOI:10.1007/s10140-017-1535-1.
[19] 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.Applicable values of serum C-reactive protein, interleukin 6 and procalcitonin in acute complex pediatric appendicitis[J].J Clin Ped Sur, 2021, 20(1):60-64.DOI:10.12260/lcxewkzz.2021.01.012.
[20] Bickell NA, Aufses AH Jr, Rojas M, et al.How time affects the risk of rupture in appendicitis[J].J Am Coll Surg, 2006, 202(3):401-406.DOI:10.1016/j.jamcollsurg.2005.11.016.
[21] Bonadio W.Time to appendectomy and risk of complicated appendicitis and adverse outcomes in children[J].JAMA Pediatr, 2018, 172(1):94.DOI:10.1001/jamapediatrics.2017.4095.
相似文献/References:
[1]俞钢 朱小春 葛午平 林炎坤 金龙 劳伟华 史浩 肖尚杰 洪淳 周佳亮 傅晓静. 胎儿外科相关疾病的产前诊断及干预[J].临床小儿外科杂志,2011,10(02):111.
The antenatal diagnosis, tassessment, and therapy of fetal surgical anomalies[J].Journal of Clinical Pediatric Surgery,2011,10(09):111.
[2]刘金桥 何静波 陈文娟 陈叶 杨芳 尹海燕.高频超声及彩色多普勒对小儿睾丸肿瘤的诊断价值[J].临床小儿外科杂志,2011,10(02):130.
[J].Journal of Clinical Pediatric Surgery,2011,10(09):130.
[3]李萌,于增文,李索林,等.超声多普勒血管显像在内结扎法腹腔镜脾切除术中的应用[J].临床小儿外科杂志,2008,7(03):4.
[4]解承兰,张兰,傅廷亮,等.胎儿腹部病变的产前诊断及围产期处理[J].临床小儿外科杂志,2007,6(02):5.
[5]刘辉,林琼,傅忠,等.超声诊断先天性肥厚性幽门狭窄20例[J].临床小儿外科杂志,2007,6(02):20.
[6]罗远建,金科,甘青,等.儿童神经母细胞瘤的影像学表现[J].临床小儿外科杂志,2007,6(02):22.
[7]杨虎,王鹏,李娟,等.小儿阑尾炎诊治87例[J].临床小儿外科杂志,2007,6(03):25.
[8]李长春 王珊 章均 欧阳军 孔祥如 杨超 赵珍珍 吕麟亚. B超引导下芯针穿刺活检术诊断儿童实体肿瘤的临床分析[J].临床小儿外科杂志,2011,10(04):247.
[J].Journal of Clinical Pediatric Surgery,2011,10(09):247.
[9]陈文娟 段星星 李皓 张雪华 胡原 张号绒. 高频超声对疑似发育性髋关节异常患儿髋关节发育的评估价值[J].临床小儿外科杂志,2011,10(05):345.
[J].Journal of Clinical Pediatric Surgery,2011,10(09):345.
[10]张豪 钱蔷英 阮双岁. 424例儿童阴囊内疾病的超声诊断分析[J].临床小儿外科杂志,2011,10(05):357.
[J].Journal of Clinical Pediatric Surgery,2011,10(09):357.
[11]周路遥 何秋明 朱莉玲 张遇乐 贺雪华 符柳江 夏慧敏. 术前超声评估可疑阑尾炎123例分析[J].临床小儿外科杂志,2011,10(04):270.
[J].Journal of Clinical Pediatric Surgery,2011,10(09):270.
备注/Memo
收稿日期:2021-07-11。
基金项目:武汉市卫生局科研项目（WG13B11）
通讯作者:杨俊,Email:yang12391@tom.com