术前炎症指标与小儿急性阑尾炎诊治策略的相关性研究

Correlation between preoperative inflammation indexes with diagnosis and treatment strategy of acute appendicitis in pediatric patients

目的探讨术前炎症指标与小儿急性阑尾炎(acute appendicitis,AA)严重程度、诊治策略的相关性。方法回顾性分析2017年1月至2021年4月广西壮族自治区人民医院收治的149例小儿AA且行腹腔镜下阑尾切除术患者的临床资料,根据病理结果分为单纯性阑尾炎组(28例)、复杂性阑尾炎组(121例,其中化脓性阑尾炎85例,坏疽性阑尾炎36例)。采用单因素分析比较两组间基线资料与术前炎症指标的差异,采用二元Logistic回归筛选复杂性阑尾炎的独立危险因素,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线。结果在术前的单纯性阑尾炎组和复杂性阑尾炎组中,发热例数分别为8例(28.6%)和66例(54.5%);白细胞计数(white blood cell count,WBC)分别为(10.95±5.50)×10^(9)/L和(15.81±5.12)×10^(9)/L;中性粒细胞百分比(neutrophil count percentage,NEUT%)分别为(67.49±16.97)%和(82.84±7.99)%;C反应蛋白(C-reactive protein,CRP)分别为(17.77±26.06)mg/L和(83.84±68.47)mg/L;CRP/白蛋白(albumin,ALB)分别为(0.61±1.13)和(1.97±1.78);前白蛋白(prealbumin,PAB)分别为(189.61±50.91)mg/L和(152.93±57.92)mg/L;以上术前因素差异均有统计学意义(P<0.05)。术前NEUT%(OR=1.096,95%CI:1.027~1.170)、CRP(OR=1.045,95%CI:1.006~1.085)是导致复杂性阑尾炎的独立危险因素(P<0.05)。术前NRUTR及CRP所对应的曲线下面积分别为0.801、0.839(P<0.05)。复杂性阑尾炎术前NEUT%的临界值为77.75%,术前CRP临界值为28.27 mg/L。将CRP临界值28.27 mg/L转为二分类变量,求得相对危险度为1.659(95%CI:1.321~2.083)。结论术前实验室检验NEUT%、CRP水平有助于预测小儿复杂性阑尾炎。若患儿术前NEUT%≥77.75%或者CRP≥28.27 mg/L,则术前诊断倾向于复杂性阑尾炎,应积极手术治疗。

Objective To explore the correlation between preoperative inflammation parameters and severity of acute appendicitis(AA)in children.Methods From January 2017 to April 2021,149 hospitalized AA children undergoing laparoscopic appendectomy were recruited as research subjects.According to the post-operative pathological results,they were assigned into two groups of uncomplicated appendicitis(n=28)and complicated appendicitis(n=121).The latter group included 85 cases of purulent appendicitis and 36 cases of gangrene appendicitis.Univariate analysis was performed for comparing the inter-group differences of baseline profiles and preoperative inflammatory parameters.Binary Logistic regression analysis was performed for determining the independent risk factors of complicated appendicitis.Finally receiver operating characteristic(ROC)curve was plotted for evaluating the diagnostic value of inflammatory parameters for complicated appendicitis.Results In the preoperative uncomplicated appendicitis group and complicated appendicitis group,The number and proportion of fever cases or not was respectively[8 cases(28.6%)and 20 cases(71.4%)]vs.[66 cases(54.5%)and 55 cases(45.5%)],white blood cell count(WBC)(10.95±5.50)vs.(15.81±5.12)×10^(9)/L,neutrophil count percentage(NEUT%)(67.49±16.97)vs.(82.84±7.99)%,C-reactive protein(CRP)was(17.77±26.06)vs.(83.84±68.47)mg/L,CRP/ALB(albumin,ALB)were(0.61±1.13)vs.(1.97±1.78),prealbumin(PAB)(189.61±50.91)vs.(152.93±57.92)mg/L,and all above these difference was significant statistical(P<0.05).Preoperative NEUT%(OR=1.096,95%CI:1.027~1.170)and CRP(OR=1.045,95%CI:1.006~1.085)were independent risk factors for complicated appendicitis(P<0.05).The areas under the curve of NRUT%and CRP were 0.801 and 0.839,respectively(P<0.05).The critical preoperative NEUT%and CRP values for complex appendicitis were 77.75%and 28.27 mg/L respectively.The critical CRP value of 28.27mg/L was converted into a binary variable,and the calculated relative risk was 1.659(95%CI:1.321-2.083).Conclusion Preoperative levels of NEUT%and CRP are valuable for predicting complicated appendicitis in children.When NEUT%≥77.75%or CRP≥28.27 mg/L occurs preoperatively,preoperative diagnosis of complicated appendicitis is more likely in AA children.Surgery should be promptly performed.