急性阑尾炎患者白细胞分类计数诊断价值及验证

Diagnostic value of hemomyelogram for acute appendicitis

目的通过对721例确诊为急性阑尾炎患者术前白细胞分类计数的回顾性研究,分析白细胞分类计数能否提示该疾病严重程度,寻找阑尾炎穿孔的最佳血常规指标。方法回顾性分析长沙市某大型三甲医院2010年1月~2013年6月普外科行阑尾切除患者共721例,分析白细胞分类计数与急性阑尾炎严重程度的相关性,利用ROC曲线评估白细胞分类计数指标对阑尾炎穿孔的诊断价值,找到最适指标截断值。另设置验证组467例,用以评价截断值的诊断能力。结果随急性阑尾炎严重程度变化幅度最大的是淋巴细胞百分比,提示阑尾炎穿孔的白细胞分类最佳指标是淋巴细胞绝对值,其小于1.83提示可能存在穿孔,灵敏度较高,具有一定的临床参考价值。结论淋巴细胞降低对辅助判断急性阑尾炎严重程度具有重要意义。

Objective To analyze the relationship between hemomyelogram and sererity of acute appendicitis and identify the best routine blood test feature for perforation. Methods 721 patients were included in this study,all of whom underwent appendectomy for the clinical diagnosis of appendicitis during the years of 2010- 2013. The initial preoperative hemomyelogram was evaluated at different stages of appendicitis. The area under the ROC curve was used to assess the clinical feature with greater diagnostic accuracy of perforation. Total lymphocyte counts of 1.83 was used in the prediction of perforative appendicitis. A group of 467 patients was used for validation to confirm the diagnostic value of the cut-off value.Results The percentage of lymphocytes had the closest association with the evolutionary phase of acute appendicitis. Total lymphocyte counts or=1.83 indicated perforation, with high sensitivity and low specificity. Conclusion The percentage of lymphocytes and total lymphocyte counts are helpful as a diagnostic paramete for different stages of acute appendicitis.