摘要
目的探讨超声特征、Alvarado评分与血液炎症标志物联合检测在小儿阑尾炎诊断和分型中的意义。方法回顾性选取2019年8月至2020年12月在安徽省儿童医院就诊的小儿急性阑尾炎120例作为观察组,同时选取非特异性腹痛患儿60例作为对照组。比较2组Alvarado评分、血清C反应蛋白(CRP)差异;分析超声联合Alvarado评分、CRP诊断急性阑尾炎及分型的价值。结果观察组Alvarado评分、CRP分别为(7.20±1.15)分、(37.54±11.46)ng/mL,明显高于对照组[(4.50±1.10)分、(21.05±9.87)ng/mL],差异均有统计学意义(P<0.05)。Alvarado评分、CRP判断急性阑尾炎的受试者工作特征(ROC)曲线下面积分别为0.892和0.781,具有诊断价值(P<0.05)。超声联合Alvarado评分、CRP诊断急性阑尾炎的敏感度为97.50%,高于超声检查的90.00%,差异有统计学意义(P<0.05),超声联合Alvarado评分、CRP诊断急性阑尾炎的特异度、阳性预测值、阴性预测值与单独超声比较,差异无统计学意义(P>0.05)。单纯性阑尾炎患儿CRP为(31.54±6.87)ng/mL,高于化脓性、坏疽性阑尾炎患儿[(39.12±7.11)、(41.39±8.06)ng/mL],差异均有统计学意义(P<0.05);坏疽性阑尾炎有靶环征比例为55.00%,低于单纯性、化脓性阑尾炎(93.55%、85.51%),差异有统计学意义(P<0.05)。CRP判断非单纯性阑尾炎的ROC曲线下面积分别为0.763,截断值分别为36.60 ng/mL,敏感度分别为82.00%,特异度分别为70.00%,具有诊断价值(P<0.05);超声联合CRP诊断非单纯性阑尾炎的敏感度为92.13%,高于单纯超声诊断(79.78%),差异有统计学意义(P<0.05)。结论超声联合Alvarado评分、CRP诊断小儿急性阑尾炎及分型有较好的应用价值,值得临床使用。
Objective To explore the significance of combined detection of ultrasound features,Alvarado score and blood inflammatory markers in the diagnosis and classification of appendicitis in children.Methods A retrospective study was conducted,120 children with acute appendicitis in Anhui Children's Hospital from August 2019 to December 2020 were selected as the observation group,and 60 children with nonspecific abdominal pain were selected as the control group,the Alvarado score,serum C-reactive protein(CRP)were compared between the two groups,the value of ultrasound combined with Alvarado score,CRP in the diagnosis and classification of acute appendicitis were analyzed.Results The Alvarado score and CRP in the observation group were(7.20±1.15)points and(37.54±11.46)ng/mL,which were significantly higher than those in the control group[(4.50±1.10)points,(21.05±9.87)ng/mL],and the differences were statistically significant(P<0.05).The area under the receiver operating characteristic(ROC)curve of Alvarado score,CRP for acute appendicitis was 0.892,0.781,respectively(P<0.05).The sensitivity of ultrasound combined with Alvarado score and CRP in the diagnosis of acute appendicitis was 97.50%,which was higher than 90.00% of ultrasound examination,the difference was statistically significant(P<0.05).Compared with ultrasound alone,there was no significant difference in the specificity,positive predictive value,and negative predictive value of ultrasound combined with Alvarado score and CRP in the diagnosis of acute appendicitis(P>0.05).The CRP of children with simple appendicitis was(31.54±6.87)ng/mL,which was higher than that of children with purulent and gangrenous appendicitis[(39.12±7.11),(41.39±8.06)ng/mL],and the difference was statistically significant(P<0.05).The proportion of gangrenous appendicitis with target ring sign was 55.00%,which was lower than that of simple appendicitis and suppurative appendicitis(93.55%,85.51%),the difference was statistically significant(P<0.05);The area under ROC curve of CRP in the diagnosis of non simple appendicitis were 0.763 and 0.788,respectively.The sensitivity of ultrasound combined with CRP to diagnose non-simple appendicitis was 92.13%,which was higher than that of ultrasound alone(79.78%),and the difference was statistically significant(P<0.05).Conclusion Ultrasound combined with Alvarado score,CRP has good application value in the diagnosis and classification of acute appendicitis in children,which is worthy of clinical use.
作者
路娟
吴梦琦
沈琪
LU Juan;WU Meng-qi;SHEN Qi(Department of Ultrasound,Anhui Hospital,Pediatric Hospital of Fudan University/Anhui Children's Hospital,Hefei Anhui 230051,China)
出处
《临床和实验医学杂志》
2021年第14期1553-1557,共5页
Journal of Clinical and Experimental Medicine
基金
安徽省卫生和计划生育委员会妇儿课题(编号:BFR018)。
