实验室检查在急性阑尾炎诊断中的作用

The diagnostic significance of laboratory finding in acute appendidtis

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1月生12月本院收治121例急性阑尾炎患者，术前行实验室检查并对比术中所见（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 与轻型阑尾炎（单纯性、化脓性）比较，重型阑尾炎（坏疽性、穿孔性、坏疽合并穿孔性）的中性粒细胞百分比高（t检验，P〈0．01；χ^2检验，P=0．015）、胆红素增高异常[总胆红素（TB）：t检验，P〈0．01，χ^2检验，P〈0．01；直接胆红素（DB）：t检验，P=0．032，χ^2检验，P〈0．01；间接胆红素（IB）：t检验，P〈0．01，χ^2检验，P〈0．01]。白细胞计数在重型与轻型之间无显著差异（t检验和χ^2检验双重证实）。被调查的患者中有109例（90．1％）表现了不同形式的肝功异常。结论 急性阑尾炎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，胆红素异常多提示重型阑尾炎，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 disease severity and leukocyte count, polymorphonuclear neutrophils （PMN） percentage and bilirubin lever in acute appendicitis. Methods One hundred and twenty one patients with acute appendicitis were analyzed retrospectively at Beijing Friendship Hospital from Janurary 2004 to December 2004. Laboratory findings were compared with what found during the operation. T test and chi-square test were performed for statistical analysis. Results In the severe group （ gangrenous, perforative and gangrenous with perforative appendicitis）, PMN percent （ t test, P 〈 0.01; chi-square test, P = 0.015） and bilirubin level [TB （total bilirubin）： t test, P 〈0.01, chi-square test, P 〈0.01; DB （direct bilirubin）： t test, P = 0.032, chi-squaro test, P 〈 0.01; IB （indirect bilirabin） t test, P 〈 0.01, chi-square test, P 〈 0.01 ] were higher than those in slight group （simple and suppurative appendicitis） . Two groups had no difference in leukocyte count （both t test and chi-square test）. One hundred and nine patients （90. 1% ） presented abnormal liver function. Conclusions PMN percent was more accurate in predicting the severility of the appendicitis compared with the leukocyte count. The abnormity of bilirubin level might be an indicator of the severe appendicitis. The local anatomic features played an important role in abnormal liver function caused by the acute appendicitis.