改良Alvarado评分系统在成人急性阑尾炎分型诊断中的应用价值

Significance of The Modified Alvarado Score System in Diagnosis of Different Types of Acute Appendicitis in Adults

目的探讨改良Alvarado评分系统在急性阑尾炎分型诊断中的应用价值。方法回顾性收集2004年1月至2014年1月期间于榆林市第一医院行手术且术后病理学检查确诊为急性阑尾炎的成人住院患者1 930例,采用改良Alvarado评分系统进行评分,分析改良Alvarado评分系统得分与急性阑尾炎病理学分型的关系,并绘制受试者工作特征（ROC）曲线,以探讨改良Alvarado评分系统对急性阑尾炎分型诊断的最佳诊断截点。结果1930例急性阑尾炎患者中,包括单纯型344例,进展型1586例。单纯型组患者的改良Alvarado评分系统得分为1-9分、（3.6±0.7）分;进展型组为1-10分、（7.5±1.3）分,进展型组的得分较高（P〈0.001）。改良Alvarado评分系统判断急性阑尾炎分型的价值较高,ROC曲线下面积（AUC）为0.943（95%CI：0.929-0.958,P〈0.001）;最佳诊断截点为6分,此时灵敏度为92.9%,特异度为86.3%,阳性预测值为96.9%,阴性预测值为72.6%,阳性似然比为6.8,阴性似然比为0.1,约登指数为91.7%。结论改良Alvarado评分系统对于急性阑尾炎的分型诊断具有一定的价值。

Objective To study the diagnostic signifi cance of Modifi ed Alvarado Score System for different types of acute appendicitis. Methods Clinical data of 1 930 cases of acute appendicitis, who underwent appendicectomy in The First Hospital of Yulin from Jan. 2004 to Jan. 2014, were retrospectively collected. Then the diagnostic signifi cance of Modifi ed Alvarado Score System was detected and evaluated by receiver operating characteristic（ROC） curve, and its correlation with postoperative pathological results was calculated. Results The modifi ed Alvarado score of cases in progressive group was higher than that of simplex group（7.5±1.3 vs. 3.6±0.7, P〈0.001）. The areas under ROC curve of Modifi ed Alvarado Score System was 0.943（95% CI：0.929-0.958, P 〈0.001）. The critically diagnostic points of Modifi ed Alvarado Score System for differential diagnosis of simplex acute appendicitis and progressive acute appendicitis was 6 score, with sensitivity of 92.9%, specifi city of 86.3%, positive predictive value of 96.9%, negative predictive value of 72.6%, positive likelihood ratio of 6.8, negative likelihood ratio of 0.1, and Youden index of 91.7%. Conclusion This Modifi ed Alvarado Score System has a certain signifi cance for the type diagnosis of acute appendicitis.