C反应蛋白检测在急性阑尾炎手术时机选择中的作用探讨

The role of C-reactive protein as a surgical indication marker for acute appendicitis

目的探讨C反应蛋白对急性阑尾炎手术时机的指导作用。方法选择我院2012年7月至12月行阑尾切除术并同时检测了白细胞、中性粒细胞比例和C反应蛋白的患者101例,并对这些检测指标进行Logistic回归分析及ROC分析并绘制ROC曲线,分析白细胞计数、中性粒细胞比例和C反应蛋白在三种不同病理类型阑尾炎中的分布特点,并探讨三种检测指标对坏疽性阑尾炎的预测价值,从而指导是否采用手术治疗。结果 Logistic回归分析结果显示C反应蛋白是坏疽性阑尾炎患者进行手术的惟一独立危险因素,从箱状图中可以看出白细胞计数和中性粒细胞比例的分布范围在三种不同病理类型的阑尾炎中无明显界限,而在单纯性阑尾炎的C反应蛋白均在50 mg/L以下,约有75%的蜂窝织炎性阑尾炎的C反应蛋白水平在50 mg/L以下,ROC曲线也提示C反应蛋白对判断坏疽性阑尾炎的敏感性优于白细胞及中性粒细胞分类(曲线下面积分别为0.788、0.688和0.604),其截断值为51.22 mg/L。结论 C反应蛋白的水平与急性阑尾炎的病理类型相关,可以作为选择是否手术的一个参考指标。

Objective This study is an attempt to clarify the role of C-reactive protein （CRP） as a surgical indication marker for appendicitis.Methods One hundred and one patients who underwent appendectomies and had pathologically confirmed appendicitis were reviewed between July 1, 2012 and December 31, 2012. The correlation between preoperative clinical factors and the actual histological severity, and identify surgical indication markers were assessed by multivariate analyses and ROC analyses.Results Multivariate analysis showed that only the CRP level significantly differ between the surgical treatment necessary group （gangrenous appendicitis） and the possible non-surgical treatment group （catarrhalis and phlegmonous appendicitis）. The CRP level for all catarrhalis appendicitis and three fourths of phlegmonous appendicitis was less than 50 mg/L.The receiver-operating characteristic（ROC） curve indicated that the cutoff value of CRP for surgical indication of appendicitis was 51.22 mg/L and the role of CRP for surgical indication was superior to WBC and neutrophil percentage. Conclusion The CRP level is consistent with the severity of appendicitis, and considered to be a surgical indication marker for acute appendicitis.