Shu Xin,Ma Chuncan,Peng Zhiwen,et al.Specific predictive model for complications of acute appendicitis in children:value of systemic inflammatory index I and exploration of potential inflammatory mechanisms[J].Journal of Clinical Pediatric Surgery,2026,(03):280-284.[doi:10.3760/cma.j.cn101785-20260106-00006]
儿童急性阑尾炎并发症的特异性预测模型: SII的价值与潜在炎症机制探索
- Title:
- Specific predictive model for complications of acute appendicitis in children:value of systemic inflammatory index I and exploration of potential inflammatory mechanisms
- Keywords:
- Child; Acute Appendicitis; Complications; Predictive Model; Systemic Inflammatory Index; Inflammatory Mechanism
- 摘要:
- 目的 构建并验证整合系统性炎症指数(systemic inflammatory index,SII)与临床指标的低龄儿童(<3岁)急性阑尾炎并发症预测模型,开发临床工具并探索炎症机制。方法 回顾性纳入2020年6月—2024年9月湘西自治州人民医院1 109例手术患儿(<3岁低龄亚组326例),分为并发症组(210例)和无并发症组(899例),计算SII并转换为自然对数(natural logarithm of SII,LnSII),通过Logistic回归筛选独立危险因素,采用受试者操作特征(receiver operating characteristic,ROC)曲线评估模型效能,检测炎症相关指标探索机制。结果 低龄亚组并发症发生率30.06%,显著高于整体人群的18.94%(P<0.001)。多因素分析显示,年龄<1岁(OR=3.245)、体温≥38.5℃(OR=2.137)、C反应蛋白≥20 mg/L(OR=2.568)、中性粒细胞比≥75%(OR=1.982)、LnSII≥6.5(OR=3.872)为独立危险因素(均P<0.05)。基于上述指标的模型在低龄亚组曲线下面积为0.965(95%CI:0.898~0.996),显著优于单一指标。简易评分表(0~10分)以≥6分为临界值,灵敏度83.67%、特异度81.25%,高危组并发症率65.71%。炎症机制显示,并发症组CD62P、血小板-中性粒细胞聚集体、白细胞介素-6、肿瘤坏死因子-α水平显著升高,且与LnSII呈正相关(r=0.653~0.725,P<0.001)。结论 整合LnSII及4项临床指标的模型预测效能高,简易评分表可用于术前快速评估,SII通过介导中性粒细胞-血小板相互作用参与并发症发生发展。
- Abstract:
- Objective To construct and validate a predictive model for complications of acute appendicitis in young children (age <3 years) through integrating systemic inflammatory index (SII) with clinical indicators,develop clinical tools and explore the inflammatory mechanism.Methods From June 2020 to September 2024,a retrospective study was conducted for 1109 surgical children (326 cases aged under 3 years).They were divided into two groups of complication (n=210) and non-complication (n=899).Systemic inflammatory index (SII) was calculated and converted into natural logarithm (LnSII).Independent risk factors were screened through Logistic regression.And model efficacy was evaluated by ROC curves for exploring the mechanism of inflammation related indicators.Results The incidence of complications was 30.06% in younger subgroup.It was significantly higher than overall population of 18.94% (P<0.001).Multivariate analysis revealed that age <1 year (OR=3.245),body temperature ≥38.5℃ (OR=2.137),CRP ≥20 mg/L (OR=2.568),neutrophil ratio ≥75% (OR=1.982) and LnSII ≥6.5 (OR=3.872) were independent risk factors (all P<0.05).The model based upon the above indicators demonstrated a significant improvement in AUC=0.965 (95%CI:0.898~0.996) in younger subgroup as compared to a single indicator.The simple scoring scale (0-10 points) had a critical value of ≥6 points with a sensitivity of 83.67% and a specificity of 81.25% and a high-risk group complication rate of 65.71%.Inflammatory mechanism showed that the levels of CD62P,platelet neutrophil aggregates,IL-6 and TNF-α spiked significantly in complication group and were correlated positively with LnSII (r=0.653~0.725,all P<0.001).Conclusions The model integrating LnSII and four clinical indicators has high predictive power.And a simple scoring table may be utilized for rapid preoperative evaluation.SII participates in the occurrence and development of complications through mediating neutrophil platelet interactions.
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备注/Memo
收稿日期:2026-1-6。
基金项目:湖南省自然科学基金区域联合基金(2024JJ7555)
通讯作者:张帆,Email:295297286@qq.com