五岁以内儿童复杂性阑尾炎的临床预测模型探索

Clinical prediction model for complicated appendicitis in children under five years old

目的回顾性分析5岁以内儿童复杂性阑尾炎(CA)的独立危险因素并建立临床预测模型,评价该模型在5岁以内儿童CA的临床应用价值。方法对2018年1月至2021年12月在上海交通大学医学院附属儿童医院行阑尾切除术的5岁以内患儿行回顾性分析,根据术后阑尾组织是否存在坏疽及穿孔征象将患儿分成CA组和非CA组,比较两组患儿间临床特征和术前实验室检查结果差异,明确CA的独立危险因素并建立临床预测模型,通过受试者工作特征曲线对临床预测模型进行验证。结果共纳入140例患儿,其中CA组84例,非CA组56例。经单因素和二元Logistic回归分析发现,发病时间>23.5 h(OR=6.650,95%CI 2.469~17.912,P<0.05),腹部肌紧张(OR=3.082,95%CI 1.190~7.979,P<0.05)和C-反应蛋白>41 mg/L(OR=3.287,95%CI 1.274~8.480,P<0.05)为CA的独立危险因素,通过上述3项独立危险因素构建CA临床预测模型,经受试者工作特征曲线验证,曲线下面积为0.881(95%CI 0.825~0.936),灵敏度为77.4%,特异度为87.5%,阳性预测值为91.3%,阴性预测值为70.0%。结论5岁以内急性阑尾炎如果发病时间超过23.5 h、C-反应蛋白水平增高、伴随腹部肌紧张,病情进展为CA的可能性更大。通过儿科门诊常用临床信息构建的CA临床预测模型具有较好的预测效能,可为临床医生鉴别CA和非CA提供简单易行的参考方式。

Objective To retrospectively analyze the independent risk factors of complicated appendicitis(CA)in children under five years old and establish a clinical prediction model,and to evaluate the clinical application of this model.Methods A retrospective analysis was performed on children under five years old who underwent appendectomy at Children′s Hospital of Shanghai Jiao Tong University School of Medicine from January 2018 to December 2021.The children were divided into CA group and uncomplicated appendicitis group according to whether there was sign of perforation or gangrene in appendiceal tissue after operation.The differences in clinical features and preoperative laboratory test results between two groups were compared.The independent risk factors of CA were identified and a clinical prediction model was established.The clinical prediction model was verified by receiver operating characteristic curve.Results A total of 140 children were enrolled in this study,including 84 cases in the CA group and 56 cases in uncomplicated appendicitis group.Univariate and binary Logistic regression analysis showed that the duration of symptoms>23.5 h(OR=6.650,95%CI 2.469-17.912,P<0.05),abdominal muscle tension(OR=3.082,95%CI 1.190-7.979,P<0.05)and C-reactive protein>41 mg/L(OR=3.287,95%CI 1.274-8.480,P<0.05)were independent risk factors for CA(P<0.05).The clinical prediction model of CA was constructed by the above mentioned three independent risk factors.The area under the receiver operating characteristic curve of the clinical prediction model was 0.881(95%CI 0.825-0.936),the sensitivity was 77.4%,the specificity was 87.5%,the positive predictive value was 91.3%and the negative predictive value was 70.0%.Conclusion Acute appendicitis in children under five years old is more likely to progress to CA if the duration of symptoms>23.5 h,the level of C-reactive protein is increased,and the abdominal muscle tension is accompanied.The clinical prediction model of CA constructed by common clinical information in pediatric clinics has good prediction efficiency,which provides a simple and feasible reference method for clinicians to distinguish CA from uncomplicated appendicitis.