血清MIP-1α联合PTX-3检测在小儿急性阑尾炎诊断及病理分型中的应用

Application of Serum MIP-1α Combined with PTX-3 Detection in the Diagnosis and Pathological Classification of Children with Acute Appendicitis

目的探讨血清MIP-1α联合PTX-3检测在小儿急性阑尾炎诊断及病理分型中的应用,为治疗方案制定提供依据。方法分析2018年11月1日-2020年1月31日某院收治的急性阑尾炎患儿138例纳入研究组,选取同期50例体检健康儿童为对照组,经手术和病理结果将研究组进一步划分为坏疽性阑尾炎及穿孔组(A组,60例)、化脓性阑尾炎组(B组,40例)和单纯性阑尾炎组(C组,38例)。采用酶联免疫吸附法检测入组患者术前及术后第5天血清MIP-1α联合PTX-3水平。采用Spearman分析MIP-1α联合PTX-3的相关性;采用logistic回归分析MIP-1α联合PTX-3的影响因素;应用受试者操作特征曲线评价MIP-1α和PTX-3预测急性阑尾炎患儿病理分型的准确性。结果术前,A组、B组和C组均和对照组的MIP-1α和PTX-3水平为[469.32±71.82vs416.23±69.87vs238.64±67.56vs192.37±7.63(ng/L)]和[1479.87±235.67 vs 1324.38±237.58 vs 882.61±134.32 vs 371.57±58.67(pg/mL)],P<0.05;而术后5天,A组和B组>对照组[261.72±55.69 vs 237.61±54.83 vs 170.83±16.85 vs 162.73±17.68(ng/L)]和[423.57±89.63 vs 385.67±79.32 vs 351.67±78.32 vs 358.73±46.38(pg/mL)],P<0.05,但C组和对照组比较,差异无统计学意义;MIP-1α和PTX-3与年龄呈显著负相关,而与总体延误时间、WBC及改良Alvarado评分呈正相关,P<0.05;logistic回归分析结果显示,年龄、总体延误时间、WBC及改良Alvarado评分均为影响MIP-1α和PTX-3的独立危险因素;ROC结果显示,MIP-1α联合PTX-3预测AA患儿病理分型的敏感度和特异度达到94.12%和90.00%,AUC值为0.940。结论AA患儿外周血MIP-1α和PTX-3水平呈异常表达,临床可通过二者的不同表达水平进而鉴别坏疽性、化脓性及单纯性AA。

Objective To explore the application of serum MIP-1α combined with PTX-3 detection in the diagnosis and pathological classification of children with acute appendicitis.Methods A retrospective analysis of 138 children with acute appendicitis admitted to our hospital from November 1,2018 to January 31,2020 was included in the study group,and 50 Healthy child with abdominal pain suspected of appendicitis during the same period were selected as the control group.The results of surgery and pathology were compared to the study group.It was further divided into gangrenous appendicitis and perforation group(group A,60),suppurative appendicitis group(group B,40 cases),and simple appendicitis group(group C,38 cases).Enzyme-linked immunosorbent assay was used to detect serum MIP-1α combined with PTX-3 levels before and on the 5 th day after operation.Spearman was used to analyze the correlation of MIP-1α combined with PTX-3;logistic regression was used to analyze the influencing factors of MIP-1α combined with PTX-3;receiver operating characteristic(ROC)curve was used to evaluate MIP-1α and PTX-3 to predict acute appendicitis Accuracy of pathological classification of children.Results Before operation,the levels of MIP-1α and PTX-3 in the four groups,group A,group B,and group C>control group,[469.32±71.82 vs416.23±69.87 vs238.64±67.56 vs192.37±7.63(ng/L)]and[1479.87±235.67 vs1324.38±237.58 vs882.61±134.32 vs 371.57±58.67(pg/m L)],P<0.05,5 days after operation,group A and group B>control group,and[261.72±55.69 vs 237.61±54.83 vs 170.83±16.85 vs 162.73±17.68(ng/L)]and[423.57±89.63 vs 385.67±79.32 vs 351.67±78.32 vs 358.73±46.38(pg/m L)]P<0.05,but there was no significant differernce between group C and control group,P>0.05.MIP-1α and PTX-3 were significantly negatively correlated with age,but positively correlated with overall delay time,WBC and modified Alvarado score(P<0.05);Logistic regression analysis showed that age,overall delay time,WBC and modified Alvarado score were all independent risk factors affecting MIP-1α and PTX-3;ROC results showed that MIP-1α combined with PTX-3 predicted the pathological type of children with AA The sensitivity and specificity reached 94.12% and 90.00%,and the AUC value was 0.940.Conclusion The levels of MIP-1α and PTX-3 in the peripheral blood of children with AA are abnormally expressed.The different levels of expression of the two can be used to distinguish gangrenous,purulent and simple AA.