改良Alvarado评分联合多层螺旋CT术前检查对急性阑尾炎分层的临床价值

Clinical value of modified Alvarado score combined with multi-slice computed tomography for preoperative stratification in acute appendicitis

目的探讨改良Alvarado评分联合多层螺旋CT(MSCT)术前检查对急性阑尾炎分层的临床价值。方法有完整腹部CT资料的临床疑似急性阑尾炎患者316例,计算改良Alvarado评分并分成低,中,高分值区。计算MSCT诊断急性阑尾炎的准确率、敏感性、特异性、阳性预测值(PPV)和阴性预测值(NPV)。结果MSCT诊断急性阑尾炎的准确率、敏感性、特异性、PPV和NPV分别为97.5%,98.6%,96.5%,96.0%和98.8%。316例患者中,146例急性阑尾炎,170例非急性阑尾炎;128例外科手术确诊。非急性阑尾炎、不复杂阑尾炎和复杂阑尾炎改良Alvarado评分分别是5.95±2.27,6.67±1.97和6.67±2.25。急性阑尾炎低、中、高分值区分布依次增多,差异有统计学意义;女性各分值区分布均低于男性。结论改良Alvarado评分对急性阑尾炎术前分层有较高的临床价值,中低分值区需求助MSCT检查。

Objective To investigate the clinical value of modified Alvarado score and muhi - slice computed tomography （MSCT） for preoperative stratification in acute appendicitis. Methods A to- tal of 316 cases of suspected acute appendicitis underwent abdominal CT scan were assessed retrospective- ly using the modified Alvarado scoring system. The patients were divided into three groups as low, median, and high group according to the modified Alvarado score. The accuracy rate, sensitivity, specificity. PPV and NPV of MSCT in the diagnosis of acute appendicitis were calculated. The difference of the modified Alvarado score between patients with and without acute appendicitis by mean and standard deviation, and the distribution of acute appendicitis among different score groups were analyzed using X2-test. Results The accuracy rate,sensitivity,specificity. PPV and NPV of MSCT were 97.5% ,98.6% ,96.5% ,96.0% and 98.8%, respectively. Among all the suspected patients, there were 146 cases of acute appendicitis and 170 cases without acute appendicitis; 128 cases of diagnosis were confirmed by surgery. The scores of un- complicated appendicitis, and complicated appendicitis and other diseases, appendicitis score were 6.67 ± 1.97,6.67 ：t： 2.25 and 5.95 ± 2.27, respectively. Distribution of acute appendicitis increased with the el- evation of Alvarado score and statistical analysis showed a significant difference in modified Alvarado scores among the groups. Women from the score distribution section were less than men. Conclusion Our Results suggest a high clinical value of modified Alvarado score for preoperative stratification in acute ap- pendicitis. MSCT scan is necessary in patients with low and median modified Alvarado score.