未成熟粒细胞百分比在预测儿童急性阑尾炎严重程度中的临床价值

Clinical value of immature granulocyte percentage in predicting severity of acute appendicitis in children

目的:探讨未成熟粒细胞百分比(IG%)及其他炎症指标联合检测在评估儿童急性阑尾炎(AA)严重程度中的临床价值。方法:纳入2022年6月—2023年8月行手术治疗的AA患儿201例,其中单纯性阑尾炎105例(ASA组),复杂性阑尾炎96例(ACA组)。比较两组白细胞(WBC)、中性粒细胞计数(ANC)、淋巴细胞计数(ALC)、中性粒细胞与淋巴细胞比值(NLR)、IG%、降钙素原(PCT)、C反应蛋白(CRP)、血小板与淋巴细胞比值(PLR)等指标的差异,Logistic回归分析构建回归模型,并利用受试者工作特征(ROC)曲线评估各指标及回归模型对ACA的诊断价值。另外,纳入2023年9月—2024年2月的AA患儿156例为验证队列,对Logistic模型进行验证,并用ROC曲线分析该模型对于ACA的诊断价值。结果:ACA组IG%、WBC、ANC、NLR、PCT、CRP和PLR水平均高于ASA组(P均<0.05),ALC水平低于ASA组(P=0.003)。Logistic回归分析显示,IG%、NLR和CRP是诊断儿童ACA的影响因素(P均<0.05),以此建立模型,以模型判断ACA的预测概率和单个炎症指标绘制ROC曲线,该模型预测概率和IG%、NLR、CRP的AUC分别为0.868和0.821、0.691和0.790,差异有统计学意义(P均<0.001)。通过独立队列验证Logistic模型,AUC为0.872,模型拟合较好,敏感度为90.0%,特异度为75.6%。结论:IG%可作为早期鉴别儿童ASA和ACA的重要指标,包括IG%、NLR、CRP这3项炎症标志物的Logistic回归模型对儿童ACA有良好的临床诊断价值。

Objective:To investigate the clinical value immature granulocyte percentage(IG%)and other inflammatory indicators in the severity of acute appendicitis.Methods:A total of 201 pediatric patients undergoing appendicitis surgery admitted to Zhoukou Central Hospital from June 2022 to August 2023 were included.Patients with pathologically confirmed actue appendicitis were divided two subgroups:actue simple appendicitis(ASA)group and actue complicated appendicitis(ACA)group,The variables that included IG%,white blood cell(WBC)count,absolute neutrophil count(ANC),absolute lymphocyte count(ALC),neutrophil to lymphocyte ratio(NLR),procalcitonin(PCT),C-reactive protein(CRP),platelet to lymphocyte(PLR)and other indexes were analyzed between ASA and ACA group.The logistic regression model for diagnosis of ACA was established,and the diagostic value of this model and other inflammtory indicators for ACA was evaluated by receiver operating characteristic(ROC)curve analysis.Results:The levels of IG%,WBC,ANC,ALC,NLR,PCT and PLR were higher and the level of ALC was lower in ACA group than those in ASA group(all P<0.05).Logistic regression analysis showed that IG%,NLR and CRP were three diagnostic determinants of ACA(all P<0.05).The AUC of the established logistic model and IG%,NLR,CRP were 0.868,0.821,0.691 and 0.790(all P<0.001).The logistic model was validated by independent cohorts,and the AUC was 0.872,the sensitivity was 90.0%and the specificity was 75.6%.Conlusions:The IG%value can early indicator for pediatric ACA,and the established logistic regression model based on biomarkers including IG%,NLR and CRP has clinical value in diagnosing ACA in children.