中性粒细胞表面CD_(64)指数在儿童急性阑尾炎早期诊断中的应用

Application of Neutrophil CD_(64) Index in the Early Diagnosis of Acute Appendicitis in Children

目的探讨外周血中性粒细胞CD64指数对于早期诊断儿童急性阑尾炎的临床应用价值。方法选择2011年12月至2013年12月于青岛市妇女儿童医院就诊,经查体和辅助影像学检查诊断为疑似急性阑尾炎的90例患儿为研究对象。对其采取外周血中性粒细胞CD64指数检测和血培养2种方法进行确诊,并将经血培养诊断确诊为急性阑尾炎的患儿纳入急性阑尾炎组。采用统计学分析方法对外周血中性粒细胞CD64指数检测诊断儿童急性阑尾炎的结果与血培养结果进行比较,并分析外周血中性粒细胞CD64指数对诊断该病的灵敏度和特异度、阳性预测值和阴性预测值。将同期于同一家医院体检的50例健康儿童纳入对照组,按照相同方法测定其外周血中性粒细胞CD64指数,并测定急性阑尾炎组与对照组受试者血常规、C反应蛋白(CRP)水平。对两组受试者的外周血中性粒细胞CD64指数、CRP水平及白细胞(WBC)计数进行统计学分析。本研究遵循的程序符合青岛市妇女儿童医院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人的知情同意,并与其签署临床研究知情同意书。结果本组疑似急性阑尾炎的90例患儿中,经血培养诊断确诊为急性阑尾炎的患儿为44例,纳入急性阑尾炎组。急性阑尾炎组与对照组患儿的年龄、性别等基线资料比较,差异无统计学意义(P>0.05)。外周血中性粒细胞CD64指数诊断急性阑尾炎的灵敏度为97.73%(43/44),特异度为95.65%(44/46),阳性预测值和阴性预测值分别为95.56%(43/45)和97.78%(44/45),诊断符合率为96.67%(88/90)。外周血中性粒细胞CD64指数对急性阑尾炎的诊断结果与血培养结果比较,差异无统计学意义(P>0.05)。急性阑尾炎组中性粒细胞CD64、CRP水平及WBC水平计数均显著高于对照组,且差异有统计学意义(P<0.001)。结论外周血中性粒细胞CD64指数检测可有效诊断儿童急性阑尾炎,并具有检测方法简单易行及诊断迅速等优点,可作为急性阑尾炎早期临床筛查手段。虽然该法诊断儿童急性阑尾炎的灵敏度和特异度均较血培养略低,但二者各有利弊,临床医师可根据实际需求合理选择诊断方法。

Objective To explore the clinical value of neutrophil CD64 index in the early diagnosis of acute appendicitis in children.Methods From December 2011 to December 2013,a total of 90 children with suspected acute appendicitis in Hospital for Women and Children of Qingdao were enrolled into this study.Neutrophil CD64 index and blood culture detections were used to diagnose acute appendicitis.And those who were diagnosed as acute appendicitis definitely by blood cultures were included into acute appendicitis group.Compare the diagnosis results of neutrophil CD64 index and blood culture detections by statistical methods.Analyze the sensitivity and specificity of neutrophil CD64 index detection.50 cases of children with normal physical examination in our hospital during the same period were included into control group.They also received neutrophil CD64 index detection as the acute appendicitis group and both the two groups received blood routine examination.Compare the neutrophil CD64 index,C-reactive protein（CRP）and white blood cell（WBC）counts between the two groups.The study protocol was approved by the Ethical Review Board of Investigation of Hospital for Women and Children of Qingdao.Informed consent was obtained from all participants′parents.Results Among the 90 children with suspected acute appendicitis,there were44 cases who were diagnosed as acute appendicitis definitely by blood cultures,and were included into acute appendicitis group.There were no significance differences between acute appendicitis group and control group in gender,age etc.baseline data（P〉0.05）.The sensitivity of neutrophil CD64 index detection was 97.73%（43/44）,the specificity was 95.65%（44/46）.The positive predictive value and negative predictive value were 95.56%（43/45）,and 97.78%（44/45）,respectively.There was no significant difference between the diagnosis results of neutrophil CD64 index and blood culture detections（P〉0.05）.The neutrophil CD64 index,levels of CRP and WBC counts in acute appendicitis group were significantly higher than those in control group（P〈0.05）.Conclusions Neutrophil CD64 index detection can be used as an effective method to diagnose and early clinical screen acute appendicitis in children for its advantages of simple and rapid diagnosis.Though the sensitivity and specificity of neutrophil CD64 index detection are slightly lower than those of blood culture detection,they both have their advantages and disadvantages,clinicians should make a reasonable choice between the two methods according to the actual situation.