血清MIP-1α联合PCT对小儿急性阑尾炎的诊断价值研究

Study on the Diagnostic Value of Serum MIP-1αCombined with PCT in Children with Acute Appendicitis

目的探究血清巨噬细胞炎性蛋白1α(Macrophage inflammatory protein 1α,MIP-1α)联合降钙素原(procalcitonin,PCT)对小儿急性阑尾炎(Acute appendicitis,AAS)的诊断价值,旨在提高小儿术前诊断准确性,有助于小儿AAS病理分型诊断,指导临床合理选择治疗方法。方法分析2019年11月1日至2020年9月30日于某院儿外科住院的100例初诊为AAS患儿临床资料,记为AAS组,根据手术病理结果将100例AAS患儿分为3组,包括单纯性组43例,化脓性组35例,穿孔性组22例。同期选取入院体检且无感染病灶、血常规正常的健康儿童50例为对照组。所有受试患者均检测血清中MIP-1α和PCT的表达,绘制受试者工作特征(ROC)曲线,分析两者单独诊断及联合诊断小儿AAS的诊断效能,同时应用二元Logistic回归分析小儿AAS的危险因素。结果AAS组血清MIP-1α和PCT水平显著高于对照组,组间差异具有统计学差异(P<0.05);术前,单纯性组血清MIP-1α和PCT水平<化脓性组<穿孔性组,各组间差异均有统计学意义(P<0.05);同时三组患者术后3天、7天的血清MIP-1α和PCT随着时间的推移,下降程度是不相等的,但同一时刻单纯性组MIP-1α和PCT的数值<化脓性组<穿孔性组,各组间差异均有统计学意义(P<0.05);二元Logistic回归方程分析,结果显示,血清MIP-1α和PCT是小儿AAS发病的独立危险因素(P<0.05);ROC曲线显示,血清MIP-1α和PCT诊断小儿AAS发病的AUC分别为0.770、0.799,而两者联合诊断时AUC为0.920,此时敏感度、特异度及准确率最高分别为83.49%、78.20%及81.40%。结论血清MIP-1α联合PCT具有良好的互补性,能有效提高小儿术前诊断准确性,且有助于小儿AAS病理分型诊断,对临床科学治疗有指导作用,值得临床推广。

Objective To explore the diagnostic value of serum macrophage inflammatory protein-1α(MIP-1α)combined with procalcitonin(PCT)in children with acute appendicitis(AAS),in order to improve the accuracy of preoperative diagnosis in children,contribute to the pathological diagnosis of AAS,and guide the clinical rational selection of treatment methods.Methods The clinical data of 100 children with newly diagnosed AAS hospitalized in pediatric surgery department of a hospital from November 1,2019 to September 30,2020 were analyzed and recorded as AAS group.According to the surgical and pathological results,100 children with AAS were divided into three groups,including 43 cases of simple group,35 cases of suppurative group and 22 cases of perforated group.At the same time,50 healthy children without infection focus and normal blood routine were selected as the control group.All tested patients were tested for the expression of MIP-1αand PCT in serum,and the receiver operating characteristic(ROC)curve was drawn,and the diagnostic efficiency of the two alone and combined diagnosis of pediatric AAS was analyzed.At the same time,the binary Logistic regression was used to analyze pediatric AAS.Risk factors.Results The serum MIP-1αand PCT levels in the AAS group were significantly higher than those in the control group,and the differences between the groups were statistically significant(P<0.05);before the operation,the serum MIP-1αand PCT in the simple group<the value of the purulent group<the value of the perforated group,and the differences between the groups were statistically significant(P<0.05).At the same time,the levels of serum MIP-1αand PCT levels of the three groups of patients at 3 and 7 days after surgery did not decrease equally over time,but at the same time the serum MIP-1αand PCT in the simple group<the value of the purulent group<the value of the perforated group,and the differences between the groups were statistically significant(P<0.05);Binary Logistic regression analysis showed that serum MIP-1αand PCT were independent risk factors for the onset of AAS in children(P<0.05);ROC curve showed that serum MIP-1αand PCT were used to diagnose AUC in children with AAS.ROC curve showed that the AUC of serum MIP-1αand PCT in the diagnosis of AAS in children were 0.770 and 0.799 respectively,while the AUC was 0.920 when they were combined.At this time,the sensitivity,specificity and accuracy were the highest at 83.49%,78.20%and 81.40%,respectively.Conclusion The combination of serum MIP-1αand PCT has good complementarity,can effectively improve the accuracy of preoperative diagnosis in children,and is helpful for the diagnosis of AAS pathological classification in children.It has a guiding role in clinical scientific treatment and is worthy of clinical promotion.