hs-CRP与PCT在老年急性阑尾炎中的临床诊断价值
|
摘要
目的:探究超敏C-反应蛋白(hs-CRP)及降钙素原(PCT)在老年急性阑尾炎患者中的临床诊断价值。方法:回顾性分析我院2015-04—2016-12期间收治的考虑诊断为急性阑尾炎并行手术治疗的老年患者118例,根据术中所见以及术后病理检查报告,将118例老年急性阑尾炎患者分为急性单纯性阑尾炎组(单纯组,56例)以及急性复杂型阑尾炎组(复杂组,62例)。分别测定两组老年急性阑尾炎患者的血清hs-CRP、CRP、PCT、WBC的值,并进行单因素及多因素分析。运用受试者工作特征(ROC)曲线,比较hs-CRP与CRP、PCT、WBC单独检测与联合检测对老年人急性复杂型阑尾炎的预测价值。结果:与单纯组相比较,复杂组患者血清hs-CRP、CRP、PCT、WBC均显著升高(P<0.05)。多因素Logistic回归分析结果显示,hs-CRP、PCT、CRP是老年急性阑尾炎诊断为急性复杂型阑尾炎的独立危险因素(P<0.05)。通过ROC曲线发现,hs-CRP、PCT、CRP的曲线下面积(AUC)分别为0.914、0.844、0.758,联合检测hs-CRP+PCT+CRP的AUC为0.946(P<0.001)。联合检测hs-CRP+PCT+CRP的敏感度为90.3%,特异度为94.6%,均较单独检测显著增高(P<0.001)。结论:hs-CRP与PCT对老年急性阑尾炎患者进行早期鉴别急性单纯性阑尾炎和急性复杂型阑尾炎具有重要诊断价值,联合检测优于单独检测,具有一定的临床价值。
Objective: To investigate the clinical diagnostic value of high sensitivity C-reactive protein(hs-CRP) and procalcitonin(PCT) in elderly patients with acute appendicitis. Method: A retrospective clinical analysis was made on 118 elderly patients with acute appendicitis from April 2015 to December 2016. According to intraoperative findings and postoperative pathological reports, 118 elderly patients with acute appendicitis were divided into acute simple appendicitis group(56 cases) and acute complex appendicitis group(62 cases). Serum hs-CRP, CRP, PCT and WBC were measured in two groups of elderly patients with acute appendicitis, and single and multiple factors were analyzed. The predictive value of hs-CRP and CRP, PCT and WBC in the elderly with acute complex appendicitis was compared by using ROC curve. Result: Compared with the simple group, the serum hs-CRP, CRP, PCT and WBC in the complex group increased significantly(P<0.05). Multivariate logistic regression analysis showed that hs-CRP, PCT and CRP were independent risk factors for the diagnosis of acute complex appendicitis in the elderly(P<0.05). The area under curve(AUC) of hs-CRP, PCT and CRP was 0.914, 0.844 and 0.758 respectively, and the AUC of combined detection of hs-CRP, PCT and CRP was 0.946(P<0.001). The sensitivity and specificity of combined detection of hs-CRP+PCT+CRP were 90.3% and 94.6% respectively, which were significantly higher than those of single detection(P<0.001). Conclusion: Hs-CRP and PCT had important diagnostic value in early differential diagnosis between acute simple appendicitis and acute complex appendicitis in the elderly. The combined detection was better than single tests, showing significant clinical value.
Objective: To investigate the clinical diagnostic value of high sensitivity C-reactive protein(hs-CRP) and procalcitonin(PCT) in elderly patients with acute appendicitis. Method: A retrospective clinical analysis was made on 118 elderly patients with acute appendicitis from April 2015 to December 2016. According to intraoperative findings and postoperative pathological reports, 118 elderly patients with acute appendicitis were divided into acute simple appendicitis group(56 cases) and acute complex appendicitis group(62 cases). Serum hs-CRP, CRP, PCT and WBC were measured in two groups of elderly patients with acute appendicitis, and single and multiple factors were analyzed. The predictive value of hs-CRP and CRP, PCT and WBC in the elderly with acute complex appendicitis was compared by using ROC curve. Result: Compared with the simple group, the serum hs-CRP, CRP, PCT and WBC in the complex group increased significantly(P<0.05). Multivariate logistic regression analysis showed that hs-CRP, PCT and CRP were independent risk factors for the diagnosis of acute complex appendicitis in the elderly(P<0.05). The area under curve(AUC) of hs-CRP, PCT and CRP was 0.914, 0.844 and 0.758 respectively, and the AUC of combined detection of hs-CRP, PCT and CRP was 0.946(P<0.001). The sensitivity and specificity of combined detection of hs-CRP+PCT+CRP were 90.3% and 94.6% respectively, which were significantly higher than those of single detection(P<0.001). Conclusion: Hs-CRP and PCT had important diagnostic value in early differential diagnosis between acute simple appendicitis and acute complex appendicitis in the elderly. The combined detection was better than single tests, showing significant clinical value.
引文
[1] 杨钰,姜春玉,郑广.老年急性阑尾炎患者术后血清炎性因子、应激反应和胃肠功能的变化[J].中国老年学杂志,2018,38(11):2650-2652.
[2] Wagner M,Tubre DJ,Asensio JA.Evolution and current trends in the management of acute appendicitis[J].Surg Clin N Am,2018,98:1005-1023.
[3] 李耀强.多排CT在急性阑尾炎穿孔与非穿孔中的鉴别诊断价值[J].临床急诊杂志,2016,17(5):393-395,398.
[4] Shin DH,Cho YS,Cho GC,et al.Delta neutrophil index as an early predictor of acute appendicitis and acute complicated appendicitis in adults[J].World J Emerg Surg,2017,12:32.
[5] 姜柳米,王进平,张敏,等.急性缺血性脑卒中患者血清NSE、hs-CRP水平与脑梗死体积、NIHSS评分的关系及临床指导意义[J].临床急诊杂志,2019,20(2):132-135.
[6] 孙令凤,王智明,雷美清,等.hs-CRP与PCT对急性淋巴细胞白血病感染的诊断评价[J].中华医院感染学杂志,2018,28(20):3076-3079.
[7] 中华人民共和国卫生部.WS 332—2011急性阑尾炎诊断[S].北京:中国标准出版社,2011:1-3.
[8] 万亚锋,王理.未成熟粒细胞计数在预测老年患者阑尾炎穿孔中的应用价值[J].中国老年学杂志,2019,39(4):833-836.
[9] Katsogridakis E,Pokusevski G,Byrne P.Acute appendicitis presenting as a complicated inguinal hernia:a case of left-sided Amyand’s hernia in an elderly man[J].J Surg Case Rep,2017,17(11):224-226.
[10] Kumar S,Jalan A,Patowary BN,et al.Laparoscopic appendectomy versus open appendectomy for acute appendicitis:a prospective comparative study[J].Kathmandu Univ Med J(KUMJ),2016,14(55):244-248.
[11] 华科俊,胡贤杰,张星,等.炎性指标在阑尾炎穿孔诊断中的价值研究[J].中国全科医学,2017,20(17):2139-2142.
[12] Haijanen J,Sippola S,Gr?倠nroos J,et al.Optimising the antibiotic treatment of uncomplicated acute appendicitis:a protocol for a multicentre randomised clinical trial(APPAC II trial)[J].BMC Surg,2018,18:117.
[13] Tayfur M,Balci MG.Pathological changes in appendectomy specimens including the role of parasites:A retrospective study of 2400 cases of acute appendicitis[J].Niger J Clin Pract,2019,22(2):270-275.
[14] Song DW,Park BK,Suh SW,et al.Bacterial culture and antibiotic susceptibility in patients with acute appendicitis[J].Int J Colorectal Dis,2018,33:441-447.
[15] Sallinen V,Akl EA,You JJ,et al.Meta-analysis of antibiotics versus appendicectomy for non-perforated acute appendicitis[J].Br J Surg,2016,103(6):656-667.
[16] 唐一鹏,陈庆良,姜楠,等.老年钙化性主动脉瓣狭窄与外周血炎性细胞及血脂水平的关系[J].天津医药,2018,46(5):466-470.
[17] Kim OH,Cha YS,Hwang SO,et al.The use of delta neutrophil index and myeloperoxidase index for predicting acute complicated appendicitis in children[J].Plos One,2016,11(2):e0148799.
[18] 艾龙龙,张玉江,张童鑫,等.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[J].中国全科医学,2018,21(32):3961-3966.
[19] 陈颖婷,王会敏,郑智明,等.血清降钙素原和白细胞介素-6在诊断成人急性阑尾炎穿孔中的价值[J].检验医学与临床,2018,15(3):332-334.
[20] 陈军,范国峰.超敏C反应蛋白在预测药物治疗急性阑尾炎疗效中的作用[J].中华急诊医学杂志,2016,25(1):88-90.
[2] Wagner M,Tubre DJ,Asensio JA.Evolution and current trends in the management of acute appendicitis[J].Surg Clin N Am,2018,98:1005-1023.
[3] 李耀强.多排CT在急性阑尾炎穿孔与非穿孔中的鉴别诊断价值[J].临床急诊杂志,2016,17(5):393-395,398.
[4] Shin DH,Cho YS,Cho GC,et al.Delta neutrophil index as an early predictor of acute appendicitis and acute complicated appendicitis in adults[J].World J Emerg Surg,2017,12:32.
[5] 姜柳米,王进平,张敏,等.急性缺血性脑卒中患者血清NSE、hs-CRP水平与脑梗死体积、NIHSS评分的关系及临床指导意义[J].临床急诊杂志,2019,20(2):132-135.
[6] 孙令凤,王智明,雷美清,等.hs-CRP与PCT对急性淋巴细胞白血病感染的诊断评价[J].中华医院感染学杂志,2018,28(20):3076-3079.
[7] 中华人民共和国卫生部.WS 332—2011急性阑尾炎诊断[S].北京:中国标准出版社,2011:1-3.
[8] 万亚锋,王理.未成熟粒细胞计数在预测老年患者阑尾炎穿孔中的应用价值[J].中国老年学杂志,2019,39(4):833-836.
[9] Katsogridakis E,Pokusevski G,Byrne P.Acute appendicitis presenting as a complicated inguinal hernia:a case of left-sided Amyand’s hernia in an elderly man[J].J Surg Case Rep,2017,17(11):224-226.
[10] Kumar S,Jalan A,Patowary BN,et al.Laparoscopic appendectomy versus open appendectomy for acute appendicitis:a prospective comparative study[J].Kathmandu Univ Med J(KUMJ),2016,14(55):244-248.
[11] 华科俊,胡贤杰,张星,等.炎性指标在阑尾炎穿孔诊断中的价值研究[J].中国全科医学,2017,20(17):2139-2142.
[12] Haijanen J,Sippola S,Gr?倠nroos J,et al.Optimising the antibiotic treatment of uncomplicated acute appendicitis:a protocol for a multicentre randomised clinical trial(APPAC II trial)[J].BMC Surg,2018,18:117.
[13] Tayfur M,Balci MG.Pathological changes in appendectomy specimens including the role of parasites:A retrospective study of 2400 cases of acute appendicitis[J].Niger J Clin Pract,2019,22(2):270-275.
[14] Song DW,Park BK,Suh SW,et al.Bacterial culture and antibiotic susceptibility in patients with acute appendicitis[J].Int J Colorectal Dis,2018,33:441-447.
[15] Sallinen V,Akl EA,You JJ,et al.Meta-analysis of antibiotics versus appendicectomy for non-perforated acute appendicitis[J].Br J Surg,2016,103(6):656-667.
[16] 唐一鹏,陈庆良,姜楠,等.老年钙化性主动脉瓣狭窄与外周血炎性细胞及血脂水平的关系[J].天津医药,2018,46(5):466-470.
[17] Kim OH,Cha YS,Hwang SO,et al.The use of delta neutrophil index and myeloperoxidase index for predicting acute complicated appendicitis in children[J].Plos One,2016,11(2):e0148799.
[18] 艾龙龙,张玉江,张童鑫,等.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[J].中国全科医学,2018,21(32):3961-3966.
[19] 陈颖婷,王会敏,郑智明,等.血清降钙素原和白细胞介素-6在诊断成人急性阑尾炎穿孔中的价值[J].检验医学与临床,2018,15(3):332-334.
[20] 陈军,范国峰.超敏C反应蛋白在预测药物治疗急性阑尾炎疗效中的作用[J].中华急诊医学杂志,2016,25(1):88-90.