C-反应蛋白检测在坏疽及穿孔性阑尾炎诊断中的价值

Significance of C-reactive protein indiagnosis of gangrenous and perforated appendicitis

目的探讨C-反应蛋白(CRP)检测在坏疽及穿孔性阑尾炎(GPA)诊断中的价值。方法选择2016年10月至2017年10月蚌埠市第三人民医院收治的111例急性阑尾炎(AA)患者,患者均行阑尾切除术。根据术中所见及术后病理结果,分为急性单纯性阑尾炎(ASA)组(43例)、急性蜂窝织性阑尾炎(APA)组(48例)与坏疽及穿孔性阑尾炎(GPA)组(20例),比较3组患者白细胞(WBC)计数、中性粒细胞百分比(N%)和CRP水平,同时绘制受试者工作曲线(ROC),行logistic回归分析。结果 3组患者的CRP水平、WBC计数的差异有统计学意义(P<0.05),GPA组患者的CRP水平高于ASA、APA组,ASA组患者WBC计数水平低于APA、GPA组,差异有统计学意义(P<0.05)。logistic回归分析显示,CRP是预测GPA的危险因素(P=0.001)。ROC结果显示:CRP的诊断效率优于WBC计数和N%,WBC计数、N%和CRP的曲线下面积分别为0.617、0.610和0.797(P=0.000),CRP诊断GPA的约登指数为0.464,最佳监测点为41.94 mg/L(灵敏度为75.00%,特异性为71.43%)。结论 CRP水平在GPA患者中升高更为明显,可作为预测阑尾炎病理类型的辅助指标。

Objective To investigate the significance of C-reactive protein（ CRP） in the prediction of gangrenous and perforated appendicitis（ GPA）. Methods This analysis was based on the clinical data of 111 appendectomy cases in the Third People＇s Hospital of Bengbufrom October,2016 to October,2017. According to the surgical operation and pathological results,the sample consisted of three groups,including 43 patients with acute simple appendicitis,48 patients with acute phlegmonous appendicitis,and 20 patients with gangrenous and perforated appendicitis. Based on the following three index,the white blood cell（ WBC） count,the percentage of neutrophils（ N%）,CRP level,this study was accomplished with Logistic regression analysis and resulted in Receiver Operating Curve（ ROC）. Results The difference of CRP level and WBC count between the three groups was statistically significant（ P〈0. 05）. The level of CRP in group GPA was higher than that in group ASA and APA. The WBC count of group ASA was lower than that in APA and GPA group,and the difference was statistically significant（ P〈0. 05）. The logistic regression analysis results showed that CRP was the predictive risk factor for GPA（ P = 0. 001）. The ROC curves showed that the index CRP was superior to WBC count and N% in determining GPA. The areas under the curve were 0. 617,0. 610 and 0. 797 respectively of WBC count,N% and CRP（ P = 0. 000））,of which the Youden index was 0. 464,and the best diagnostic cutoff value was 41. 94 mg/l（ sensitivity 75. 00%,specificity 71. 43%）. Conclusion The increase of CRP level in patients with GPA is more obvious,which can be used as an auxiliary indicator for predicting the pathological type of appendicitis.