RIPASA评分和血清总胆红素及C反应蛋白在急性阑尾炎中的诊断价值研究

目的探讨RIPASA评分、血清总胆红素(TBil)、C反应蛋白(CRP)在急性阑尾炎中的诊断价值。方法选取2016年1月—2017年1月新疆医科大学第二附属医院收治的250例急性右下腹痛患者,根据腹腔镜阑尾切除术及病理检查结果将其分为急性阑尾炎组(150例)和非急性阑尾炎组(100例),急性阑尾炎组根据病理类型分为A亚组(单纯性阑尾炎18例)、B亚组(化脓性阑尾炎76例)、C亚组(坏疽穿孔性阑尾炎56例)。入院时对患者行RIPASA评分,并检测TBil及CRP水平,采用受试者工作特征(ROC)曲线分析其诊断价值。结果急性阑尾炎组RIPASA评分、TBil、CRP水平均高于非急性阑尾炎组(P<0.001)。B亚组RIPASA评分、CRP水平均高于A亚组(P<0.05);C亚组RIPASA评分、TBil、CRP水平均高于A亚组,TBil、CRP水平均高于B亚组(P<0.05)。RIPASA评分诊断急性阑尾炎的最佳临界值为7.5分,准确率为82.4%,灵敏度为88.7%,特异度为73.0%,ROC曲线下面积(AUC)为0.89[95%CI(0.84,0.93),P<0.001];TBil诊断急性阑尾炎的最佳临界值为14.15μmol/L,准确率为84.4%,灵敏度为88.7%,特异度为78.0%,AUC为0.86[95%CI(0.81,0.90),P<0.001];CRP诊断急性阑尾炎的最佳临界值为13.6 mg/L,准确率为84.0%,灵敏度为88.0%,特异度为78.0%,AUC为0.88[95%CI(0.84,0.92),P<0.001]。TBil诊断坏疽穿孔性阑尾炎的最佳临界值为20.28μmol/L,准确率为80.0%,灵敏度为89.3%,特异度为74.5%,AUC为0.89[95%CI(0.82,0.93),P<0.001];CRP诊断坏疽穿孔性阑尾炎的最佳临界值为34.0mg/L,准确率为76.0%,灵敏度为82.1%,特异度为72.3%,AUC为0.82[95%CI(0.75,0.88),P<0.001]。结论 RIPASA评分、TBil、CRP对急性阑尾炎均有诊断价值;TBil、CRP可以预测坏疽穿孔性阑尾炎。

Evaluation of modifi ed Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis

BACKGROUND: Acute appendicitis is the most common surgical condition presented in emergency departments worldwide. Clinical scoring systems, such as the Alvarado and modified Alvarado scoring systems, were developed with the goal of reducing the negative appendectomy rate to 5%–10%. The Raja Isteri Pengiran Anak Saleha Appendicitis(RIPASA) scoring system was established in 2008 specif ically for Asian populations. The aim of this study was to compare the modif ied Alvarado with the RIPASA scoring system in Kuwait population.METHODS: This study included 180 patients who underwent appendectomies and were documented as having "acute appendicitis" or "abdominal pain" in the operating theatre logbook(unit B) from November 2014 to March 2016. The sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV), diagnostic accuracy, predicted negative appendectomy and receiver operating characteristic(ROC) curve of the modified Alvarado and RIPASA scoring systems were derived using SPSS statistical software.RESULTS: A total of 136 patients were included in this study according to our criteria. The cut-off threshold point of the modif ied Alvarado score was set at 7.0, which yielded a sensitivity of 82.8% and a specif icity of 56%. The PPV was 89.3% and the NPV was 42.4%. The cut-off threshold point of the RIPASA score was set at 7.5, which yielded a 94.5% sensitivity and an 88% specif icity. The PPV was 97.2% and the NPV was 78.5%. The predicted negative appendectomy rates were 10.7% and 2.2% for the modif ied Alvarado and RIPASA scoring systems, respectively. The negative appendectomy rate decreased significantly, from 18.4% to 10.7% for the modified Alvarado, and to 2.2% for the RIPASA scoring system, which was a signif icant difference(P<0.001) for both scoring systems.CONCLUSION: Based on the results of this study, the RIPASA score is a simple scoring system with better sensitivity and specif icity than the modif ied Alvarado scoring system in Asian populations. It consists of 14 clinical parameters that can be obtained from a good patient history, clinical examination and laboratory investigations. The RIPASA scoring system is more accurate and specific than the modif ied Alvarado scoring system for Kuwait population.

RIPAS阑尾炎评分对可疑急性阑尾炎的诊断价值

目的:研究RIPAS阑尾炎(RIPASA)评分对可疑急性阑尾炎的诊断价值。方法:对2014年1月-2015年1月诊断的可疑急性阑尾炎患者150例分别以Alvarado评分和RIPASA评分进行评估,比较其诊断价值。结果:以7.5分和7分定义为RIPASA和Alvarado评分的最佳界值,RIPASA评分和Alvarado评分诊断急性阑尾炎的敏感度、特异度、阳性预测值、阴性预测值、准确率、阑尾阴性切除率分别为(97.50%、81.42%、85.71%、96.61%、90.30%、14.29%)和(68.75%、87.14%、85.93%、70.93%、73.80%、14.06%);使用RIPASA和Alvarado评分对可疑急性阑尾炎患者评估结果与综合临床诊断结果相关联,且RIPASA评分关联程度明显高于Alvarado评分(P<0.05)。结论 :急诊医师使用RIPASA评分对中国大陆地区东方人种可疑急性阑尾炎患者进行辅助诊断优于Alvarado评分。