联合应用改良Alvarado评分与CT影像判别急性阑尾炎病理类型的意义

Diagnostic value of combined modified Alvarado scores and computed tomography imaging in the pathological types of acute appendicitis in adults

目的探讨联合应用改良Alvarado评分（MAS）和CT影像在判断成人急性阑尾炎病理类型中的应用价值。方法回顾性分析青岛大学医学院附属医院2007年6月至2010年7月间收治的经手术和病理证实的396例成人急性阑尾炎患者的临床资料．对每例患者进行改良Alvarado评分．并对术前实施CT检查的115例患者的CT影像学特征进行判读。分析包括一般情况、改良Alvarado评分及CT征象在内的35项指标与急性阑尾炎病理类型的关系．取其中有统计学意义的变量建立Fisher判别函数．并进行回顾性和前瞻性考核。结果将单因素分析中有统计学意义的23项指标进行非标准化逐步判别分析，最终有体温（X1）、白细胞计数（X2）、中性粒细胞比例（X3）、MAS得分（X4）、阑尾周围脂肪条束征（X5）和腔外气体（X6）6项指标进入判别方程，判别函数为：Y1=0．012X1＋0．041X2＋0．069X3—0．039X4＋2．653X5＋1．418X6，Y2=0．327X1＋0．041X2—0．034X3—0．140X4-1．114X5-2．982X6。回顾性考核该函数对急性阑尾炎病理类型的判断准确率为76．5％（88／115），前瞻性考核其判断准确率为77．8％（21／27）。结论联合应用改良Alvarado评分和CT影像有助于判断成人急性阑尾炎的病理类型．从而指导临床合理制订治疗策略。

Objective To explore the diagnostic value of combined modified Alvarado scores （MAS） and computed tomography imaging in the pathological types of acute appendicitis in adults. Methods Clinical data of a total of 396 adult patients with acute appendicitis confirmed by surgery and pathology were analyzed retrospectively from June 2007 to July 2010. Case-control study was used to investigate the MAS. CT signs were studied in 115 patients who underwent preoperative CT scan. Univariable analysis was performed using each indicator among different pathological types. Discriminant classification was formed by applying significant variables identified from univariable analysis and a Fisher discriminant function was created. Results Twenty three variables were statistically significant among different pathological types after univariable analysis （P〈0.05） and were selected for diseriminant analysis. Six variables including temperature （X1）, leucocyte count （X2）, the proportion of neutrophil （X3）, MAS points （X4）, periappendiceal fat stranding （X5）, and extraluminal air （X6） were enrolled. The discriminant function equation was Yl=0.012X1＋0.041X2＋0.069X3-0.039X4＋2.653X5＋1.418X6, Y2 =0.327X1 ＋0.041X2-0.034X3-0.140X4-1.114X5 ＋2.982X6. The accuracy was 76.5% （88/115） in retrospective assessment and 77.8%（21/27） in prospective assessment. Conclusion The combined use of MAS and CT imaging signs is useful in identifying the pathological types of acute appendicitis in adults, so it is helpful in choosing reasonable therapeutic option for surgeons.