C反应蛋白与白蛋白比值对儿童复杂性阑尾炎预测价值的研究

Predictive value of CRP/ALB ratio for children with complex appendicitis

目的探讨C反应蛋白(C reactive protein,CRP)与白蛋白(albumin,ALB)比值(CRP/ALB)对儿童复杂性阑尾炎的预测价值及其最佳截断值。方法收集2018年12月至2019年5月收治于天津市儿童医院微创外科符合纳入标准的急性阑尾炎患儿132例。其中,男79例,女53例;年龄为(8.08±3.35)岁,年龄范围为1~15岁;单纯性阑尾炎49例,复杂性阑尾炎83例;病程时间范围为0.3~21.0 d。根据术中所见及术后病理检查结果将所有患儿分为单纯性阑尾炎组(49例)和复杂性阑尾炎组(83例)。比较两组患儿年龄、性别、体重、病程、ALB及血常规指标的相关性,通过单因素及多因素Logistic回归分析筛选可协助诊断儿童复杂性阑尾炎的指标。然后对筛选后的指标绘制接受者工作特征曲线(receiver operating characteristics curve,ROC),根据约登指数并结合敏感性及特异性评估其在诊断儿童复杂性阑尾炎中的预测价值。结果单因素分析结果显示,复杂性阑尾炎组与单纯性阑尾炎组在病程、ALB、白细胞(white blood cell,WBC)、中性粒细胞(neutrophil,NEUT)、CRP、降钙素原(procalcitonin,PCT)及CRP/ALB比值之间的差异具有统计学意义(P<0.05)。Logistic回归分析显示CRP及CRP/ALB比值是儿童复杂性阑尾炎的独立危险因素。ROC曲线分析显示,CRP/ALB比值的曲线下面积(area under the curve,AUC)高于CRP的AUC(0.847比0.819)。当CRP/ALB比值>1.305时,预测复杂性阑尾炎的约登指数最大(0.609),敏感性和特异性分别为71.1%和89.8%,阳性预测值和阴性预测值分别为92.2%和64.7%。与CRP/ALB比值<1.305相比,CRP/ALB比值>1.305的患儿确诊为复杂性阑尾炎的相对危险度为21.633[95%CI(7.649~61.181)]。结论CRP、CRP/ALB对儿童复杂性阑尾炎均有一定的预测价值,但CRP/ALB比值的敏感度和特异性更高。所以,CRP/ALB可为儿童急性阑尾炎是否选择手术治疗提供参考。

Objective To explore the predictive and optimal cut-off values of C-reactive protein (CRP) to albumin (ALB) ratio (CRP/ALB) for complex pediatric appendicitis.Methods A total of 132 children with acute appendicitis fulfilling the inclusion criteria at Municipal Children's Hospital were collected from December 2018 to May 2019. There were 79 boys and 53 girls with a mean age of (8.08±3.35)(1-15) years and a disease course of 0.3 to 21.0 days. According to intraoperative findings and postoperative pathological examination results, they were divided into two groups of simple appendicitis (n=49) and complicated appendicitis (n=83). The correlations of age, gender, weight, course of disease, ALB and blood routine parameters were compared between two groups. And the relevant factors were screened by univariate and multivariate Logistic regressions. Then the corresponding curves of receiver operating characteristics (ROC) were plotted for evaluating their predictive values on the basis of Youden index plus sensitivity and specificity.Results Univariate analysis revealed significant inter-group differences in course of disease, ALB, white blood cell (WBC), neutrophils (NEUT), CRP, procalcitonin (PCT) and CRP/ALB ratio (P<0.05). Logistic regression analysis showed that CRP and CRP/ALB ratio were independent risk factors for complex pediatric appendicitis. And ROC curve analysis indicated that the area under the AUC curve of CRP/ALB ratio was higher than that of CRP (0.847 vs 0.819). At a CRP/ALB ratio >1.305, the Youden index was the largest for predicting complex appendicitis (0.609), the sensitivity and specificity were 71.1% and 89.8% and the positive predictive and negative predictive values were 92.2% and 64.7% respectively. As compared with CRP/ALB ratio <1.305, the relative risk of complex appendicitis was 21.633 [95%CI(7.649, 61.181)] in children with CRP/ALB ratio >1.305.Conclusions CRP and CRP/ALB ratio have certain predictive values for children with complex appendicitis. However, the sensitivity and specificity of CRP/ALB ratio are higher. Therefore CRP/ALB provides references for selecting surgical options for acute pediatric appendicitis.