实验室检查在急性阑尾炎诊断中的意义

The diagnostic significance of laboratory examination in acute appendicitis

目的探讨急性阑尾炎轻重程度与白细胞计数、中性粒细胞百分比、胆红素的关系。方法2004年我院收治的121例急性阑尾炎患者,术前行实验室检查对比术中所见(术后病理)作回顾性分析,将结果进行两组独立样本计量资料的t检验和分组计数资料的四格表卡方检验。结果重型阑尾炎(坏疽性、穿孔性、坏疽合并穿孔性)较轻型阑尾炎(单纯性、化脓性)中性粒细胞百分比高(t检验,P<0.001;χ2检验,P=0.015)、胆红素增高异常〔总胆红素(TB):t检验,P<0.001;χ2检验,P<0.001;直接胆红素(DB):t检验,P=0.032,χ2检验,P<0.001;间接胆红素(IB):t检验,P<0.001,χ2检验,P=0.004〕。白细胞计数在重型与轻型之间无显著差异(t检验和χ2检验双重证实)。被调查的病例中有109例(90.1%)患者表现了不同形式的肝功异常。结论急性阑尾炎时中性粒细胞百分比较白细胞计数能更准确地反映疾病的严重程度,胆红素异常多预示重型阑尾炎,急性阑尾炎致肝功异常局部解剖特点占有相当重要的作用。

Objective To investigate the correlation between the severity of disease and leukocyte count, PMN （polymorphonuelear neutrophils） perceentage and bilirubin level in acute appendicitis. Methods One hundred and twenty one cases of acute appendicitis were analyzed retrospectively at Beijing Friendship Hospital from Jan 2004 to Dec 2004. We related the preoperative indexes of laboratory assays with the scene at surgery and postoperative pathology.T test and chi2 test were performed for statistical analyses. Results We found that in the severe group （gangrenous, pefforative and gangrenous compounded pefforative appendicitis）, the values Of PMN percent （t test, P 〈0.001; chi2 test, P 〈0.05） and bilimbin level [TB （total bilirubin） ： t test, P 〈0.001 chi2 test, P 〈 0.001; DB （direct bilirubin） t test, P 〈 0.05 chi2 test, P 〈 0.001; IB （indirect bilirubin） t test, P 〈 0.001, chi2 test, P 〈 0.01） ] were higher than those in gentle group （simple and suppurative appendicitis） . Two groups had no difference in leukocyte count （both t test and chi2 test） .In these investigated patients there were 109 cases （90.1%） presented abnormal liver function in dif- ferent forms. Conclusion PMN percent appears to be morn predictive of the severity of the appendicitis compared with the leukocyte count. The abnormity of bilimbin may be an indicator of the severe appendicitis. We consider that the local anatomic features may play an important role in liver function impairment caused by the acute appendicitis.