小儿卵巢扭转坏死的危险因素及其预测价值分析

Risk factors and predictive values of ovarian torsion necrosis in children

目的探讨小儿卵巢扭转坏死的危险因素及其预测价值。方法回顾性分析华中科技大学同济医学院附属武汉儿童医院2014年5月至2023年5月术中诊断为卵巢扭转的73例患儿临床资料。按照病理结果将患儿分为坏死组(27例)及未坏死组(46例)。比较两组患儿的年龄、侧别、恶心呕吐、发热、腹痛至手术时间、血小板、淋巴细胞、中性粒细胞、中性粒细胞百分比、C-反应蛋白值(C-reaction protein,CRP)、白细胞计数(white blood cell,WBC)、中性粒细胞与淋巴细胞的比值(neutrophil-to-lymphocyte ratio,NLR)、血小板与淋巴细胞的比值(platelet-to-lymphocyte ratio,PLR)、淋巴细胞与CRP的比值(lymphocyte to C-reaction protein,LCR)及附件肿物直径。使用单因素Logistic回归分析小儿卵巢扭转坏死的相关危险因素,多因素Logistic回归进一步分析其独立危险因素,绘制受试者工作特征(receiver operating characteristic,ROC)曲线评估各指标对小儿卵巢扭转坏死的预测价值。结果两组年龄[(7.21±3.65)岁比(8.80±4.17)岁]、侧别(左/右)(9/17比21/26)、血小板[(289.18±94.57)×10^(9)/L比(300.06±79.05)×10^(9)/L]、淋巴细胞[1.93(1.36,2.74)×10^(9)/L比1.60(1.00,2.46)×10^(9)/L]、中性粒细胞百分比[(72.25±14.23)%比(69.30±18.69)%]、NLR[6.18(3.68,8.79)比5.02(2.38,8.49)]、PLR[117.31(101.27,199.98)比181.99(104.22,282.81)]、LCR[0.39(0.05,1.45)比0.10(0.02,1.73)]、附件肿物直径[5.00(3.97,6.33)cm比4.67(3.38,6.17)cm]比较,差异均无统计学意义(P>0.05)。两组卵巢扭转度数[720.00(720.00,855.00)°比720.00(360.00,720.00)°]、恶心及呕吐例数[21例(80.77%)比27例(57.45%)]、发热例数[9例(34.62%)比2例(4.26%)]、腹痛至手术时间[72.00(31.50,96.00)h比24.00(15.84,45.60)h]、中性粒细胞[10.29(6.30,11.61)×10^(9)/L比5.98(3.67,9.04)×10^(9)/L]、CRP[9.40(0.78,36.70)mg/L比0.84(0.78,2.27)mg/L]、WBC[13.25(7.92,16.89)×10^(9)/L比8.28(6.21,11.87)×10^(9)/L]比较,差异均有统计学意义(P<0.05)。ROC曲线结果显示,腹痛至手术时间对卵巢扭转坏死的预测价值最高,最佳截断值为26.7 h,ROC曲线下面积(area under the ROC curve,AUC)为0.755,灵敏度、特异度分别为84.6%、66.0%;其次为卵巢扭转度数,其最佳截断值为405°,AUC为0.695,灵敏度、特异度分别为88.5%、42.6%;最后为发热,AUC为0.652,灵敏度、特异度分别为34.6%、95.7%。将三者联合对卵巢扭转坏死进行预测时,AUC为0.870,灵敏度、特异度分别为69.2%、93.6%。结论腹痛至手术时间、卵巢扭转度数及发热可有效预测小儿卵巢扭转坏死。

Objective To explore the risk factors and predictive values of ovarian torsion(OT)necrosis in children.Methods To summarize the clinical data of 73 children with ovarian torsion diagnosed during operation in Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science&Technologyfrom May 2014 to May 2014,and to 2023.According to the results of pathological examination,they were assigned into two groups of torsion necrosis(n=27)and non-necrosis(n=46).The age,affected side,malignant behavior and vomiting,fever,time from abdominal pain to operation,platelet,lymphocyte,neutrophil,percentage of Neutrophil,C-reaction protein(CRP),white blood cell(WBC),neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),lymphocyte-to-C-reaction protein(LCR)and the diameter of adnexal masses were compared between the two groups.Univariate Logistic regression was used to analyze the risk factors of ovarian torsion necrosis in children.Multivariate Logistic regression was used to analyze the independent risk factors,receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of each index for torsion necrosis of ovary in children.Results No significant inter-group differences existed in age[(7.21±3.65)year vs.(8.80±4.17)year],The affected side(left/right){[9(34.62%)/17(65.38%)]vs.[21(44.68%)/26(55.32%)]},platelet[(289.18±94.57)×10^(9)/L vs.(300.06±79.05)×10^(9)/L],lymphocyte[1.93(1.36,2.74)×10^(9)/L vs.1.60(1.00,2.46)×10^(9)/L],neutrophil[(72.25±14.23)%vs.(69.30±18.69)%],neutrophil-to-lymphocyte ratio(NLR)[6.18(3.68,8.79)vs.5.02(2.38,8.49)],platelet-to-lymphocyte ratio(PLR)[117.31(101.27,199.98)vs.181.99(104.22,282.81)]or lymphocyte to C-reaction protein(LCR)[0.39(0.05,1.45)vs.0.10(0.02,1.73)],the diameter of adnexal masses[5.00(3.97,6.33)cm vs.4.67(3.38,6.17)cm](P>0.05).Significant inter-group differences existed in degree of OT[720.00(720.00,855.00)°vs.720.00(360.00,720.00)°],nausea and vomiting[21(80.77%)vs.27(57.45%)],fever[9(34.62%)vs.2(4.26%)],time from abdominal pain to operation[72.00(31.50,96.00)h vs.24.00(15.84,45.60)h],neutrophil[10.29(6.30,11.61)×10^(9)/L vs.5.98(3.67,9.04)×10^(9)/L],C-reaction protein(CRP)[9.40(0.78,36.70)mg/L vs.0.84(0.78,2.27)mg/L]and white blood cell(WBC)[13.25(7.92,16.89)×10^(9)/L vs.8.28(6.21,11.87)×10^(9)/L](P<0.05).The results of ROC showed that the time from abdominal pain to operation had the highest predictive value for ovarian torsion necrosis,the best cut-off was 26.7 h,the area under the ROC curve(AUC)was 0.755,the sensitivity and specificity were 84.6%and 66.0%.The second is the degree of ovarian torsion,the best cut-off value was 405°with an AUC of 0.695,the sensitivity and specificity were 88.5%and 42.6%.Finally for fever,the AUC was 0.652,the sensitivity and specificity were 34.6%and 95.7%.Combining those three parameters,the AUC was 0.870 with a sensitivity of 69.2%and a specificity of 93.6%.Conclusions Time from abdominal pain to operation,degree of OT and fever may effectively predict the occurrence of OT necrosis in children.