术前总胆红素水平预测急性阑尾炎严重程度的临床价值

Clinical Value of Preoperative Total Bilirubin Level in Predicting the Severity of Acute Appendicitis

目的评估阑尾切除术前总胆红素水平对成人重症阑尾炎诊断的预测价值。方法回顾性分析383例行阑尾切除术的急性阑尾炎患者的病例资料,包括年龄、性别、腹膜刺激征、白细胞计数、血清总胆红素水平、入院途径和住院时间等。采用受试者工作特征曲线(ROC曲线)分析确定总胆红素水平与阑尾炎严重程度相关的最佳值,并根据总胆红素水平临界值分析临床表现差异。结果总胆红素水平临界值10.85μmol·L^(-1)可预测重症阑尾炎,敏感性77.4%,特异性88.6%。总胆红素数值增高(≥11.0)与重症阑尾炎、腹膜刺激征阳性、白细胞计数较高、首诊为急诊及住院天数较长有显著相关性(P<0.001)。多变量分析发现患者术前总胆红素≥11.0(OR 14.969,95%CI 7.619~29.408,P<0.001)是与住院时间延长相关的独立危险因素。结论术前总胆红素水平可作为重症阑尾炎的预测指标,可为是否选择手术治疗提供参考。

Objective To evaluate the predictive value of total bilirubin level before appendectomy in the diagnosis of adult severe appendicitis.Methods The case data of 383 patients with acute appendicitis who underwent appendectomy were analyzed retrospectively,including age,sex,peritoneal irritation sign,white blood cell count,serum total bilirubin level,way of admission and length of stay.The best value of the correlation between the total bilirubin level and the severity of appendicitis was determined by reciver operating characteristic curve(ROC curve)analysis,and the difference of clinical manifestations was analyzed according to the critical value of the total bilirubin level.Results The critical value of total bilirubin level of 10.85μmol·L^(-1)can predict severe appendicitis,with sensitivity of 77.4%and specificity of 88.6%.The increased value of total bilirubin(≥11.0)was significantly correlated to severe appendicitis,positive peritoneal irritation sign,higher white blood cell count,emergency treatment and longer hospitalization days(P<0.001).Multivariate analysis showed that preoperative total bilirubin≥11.0(OR 14.969,95%CI 7.619~29.408,P<0.001)was an independent risk factor associated with prolonged hospitalization.Conclusion The preoperative total bilirubin level can be used as a predictor of severe appendicitis,and can provide a reference for the choice of surgical treatment.