改良阿氏评分结合血清C反应蛋白检测对儿童急性阑尾炎的临床应用价值
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摘要
目的探讨改良阿氏评分结合血清C反应蛋白(CRP)检测对儿童急性阑尾炎(acute appendicitis,AAS)的临床应用价值。方法回顾性分析2015年11月至2016年11月期间我院儿科就诊的78例急性阑尾炎患儿为研究对象,单纯性AAS组32例,化脓性AAS组28例,穿孔性AAS组18例,选取同期体检的正常儿童10例为对照组,采用改良阿氏(Alvarado)评分结合血清CRP检测为受试患儿和正常对照组进行全面评估。结果手术前单纯性AAS组、化脓性AAS组、穿孔性AAS组CRP参数水平依次上升,且显著高于对照组,组间比较差异有统计学意义(P<0.05);单纯性AAS组、化脓性AAS组、穿孔性AAS组术后CRP参数均较术前明显下降(P<0.05),然而依然高于对照组(P<0.05)。与单纯性AAS组、化脓性AAS组比较,穿孔性AAS组患儿手术前Alvarado评分、血清CRP阳性率及二者均阳性的百分比均明显提高(P<0.05);化脓性AAS组的血清CRP阳性率与二者均阳性率明显高于单纯性AAS组(P<0.05)。结论血清CRP检测有助于儿童AAS病情诊断、病理分型以及病情程度,改良Alvarado评分联合CRP对诊断AAS具有良好的互补性,能有效提高AAS术前诊断准确性,对临床科学治疗有指导作用,值得临床推广。
Objective Objective to investigate the clinical value of modified CRP score combined with serum C-reactive protein(CRP) test in children with acute appendicitis.Methods Retrospective analysis was conducted with the data from November 2015 to November 2016,using the pediatric clinic of 78 patients with AAS in our hospital as the research object.The simple AAS group has 32 cases while suppurative AAS group has 28 cases.Also,perforation AAS group has 18 cases.10 normal children were selected as control group.We used the modified Alvarado score,then the 78 cases were divided into the high score group and lowscore group.Also,combined with the CRP detection,the AAS comprehensive assessment was performed.Results Before surgery,in the simple AAS group,AAS group,suppurative and perforative group,the CRP level increased,and significantly higher than the control group(P < 0.05); after surgery,in the simple AAS group,AAS group,suppurative and perforation AAS group,the CRP parameters were significantly decreased(P <0.05),but still higher than the control group(P < 0.05).Compared with the simple AAS group and suppurative AAS group,the AAS group with perforated has its Alvarado score before the surgery,and the positive rate of serum CRP and positive percentage were significantly increased(P < 0.05); the positive rate of serum CRP for suppurative AAS group and positive rate were significantly higher than that of group AAS(P < 0.05).Conclusion Detection of serum CRP is helpful for children AAS disease diagnosis,pathological type assessment and severity improvement.The modified Alvarado score combined with CRP have good complementary for the diagnosis of AAS,also can improve the preoperative diagnostic accuracy,so to plays a guiding role in clinical treatment,and is worthy of promotion.
Objective Objective to investigate the clinical value of modified CRP score combined with serum C-reactive protein(CRP) test in children with acute appendicitis.Methods Retrospective analysis was conducted with the data from November 2015 to November 2016,using the pediatric clinic of 78 patients with AAS in our hospital as the research object.The simple AAS group has 32 cases while suppurative AAS group has 28 cases.Also,perforation AAS group has 18 cases.10 normal children were selected as control group.We used the modified Alvarado score,then the 78 cases were divided into the high score group and lowscore group.Also,combined with the CRP detection,the AAS comprehensive assessment was performed.Results Before surgery,in the simple AAS group,AAS group,suppurative and perforative group,the CRP level increased,and significantly higher than the control group(P < 0.05); after surgery,in the simple AAS group,AAS group,suppurative and perforation AAS group,the CRP parameters were significantly decreased(P <0.05),but still higher than the control group(P < 0.05).Compared with the simple AAS group and suppurative AAS group,the AAS group with perforated has its Alvarado score before the surgery,and the positive rate of serum CRP and positive percentage were significantly increased(P < 0.05); the positive rate of serum CRP for suppurative AAS group and positive rate were significantly higher than that of group AAS(P < 0.05).Conclusion Detection of serum CRP is helpful for children AAS disease diagnosis,pathological type assessment and severity improvement.The modified Alvarado score combined with CRP have good complementary for the diagnosis of AAS,also can improve the preoperative diagnostic accuracy,so to plays a guiding role in clinical treatment,and is worthy of promotion.
引文
[1]李俊,赵家泉,张辉,等.C反应蛋白、白细胞计数、中性粒细胞百分比与阑尾炎病理类型关系.泰山医学院学报,2012,33(8):596-598.
[2]李文莲,李光贵.血清前白蛋白和C-反应蛋白在儿童感染性疾病诊断中的临床意义.临床荟萃,2011,26(19):1711-1713.
[3]吴辉.C反应蛋白、白细胞计数和中性粒细胞联合检测对急性阑尾炎诊断的临床应用价值.中国实用医药,2013,8(27):62.
[4]高立学.B超辅助选择性小切口阑尾切除术治疗急性阑尾炎.现代中西医结合杂志,2011,20(16):2017-2018.
[5]LEEUWENBURGH M M,WIARDA B M,WIEZER M J,et al.Comparison ofimaging strategies with conditional contrast-enhanced CTandunenhanced MR imaging in patients suspected of havingappendicitis:a multicenter diagnostic performance.Radiology,2013,268(1):135-143.
[6]黄爱芳.超敏C反应蛋白、白细胞计数联合检测对诊断小儿急性阑尾炎的临床意义.检验医学与临床,2012,9(20):2620-2621.
[7]杨晓峰,杨新宏,刘秋霞,等.CRP、WBC、异型淋巴细胞检测在儿童感染性疾病中的应用.承德医学院学报,2012,29(2):140.
[8]袁伟华,单蕊,谷兴琳.儿童急性阑尾炎及其并发症的CT诊断价值.江苏医药,2013,39(21):2168-2619.
[9]浦晓,张奕鹏,徐建国.血清CRP测定对5岁以下儿童急性阑尾炎诊断的价值.白求恩军医学院学报,2011,9(6):封2.
[10]PARK J S,JEONG J H,LEE J I,et al.Accuracies of diagnostic methods foracute appendicitis.Am Surg,2013,79(1):101-106.
[11]MAN E,SIMONKA Z,VARGA A,et al.Impact of the Alvarado score onthe diagnosis of acute appendicitis:comparing clinical judgment,Alvarado score,and a new modified score in suspectedappendicitis:a prospective,randomized clinical trial.Surg Endosc,2014,28(8):2398-2405.
[12]寿铁军,李勇,马能强,等.穿孔性阑尾炎患儿白细胞、中性粒细胞和C反应蛋白的检测价值.现代实用医学,2011,23(6):638.
[13]LAI V,CHAN W C,LAU H Y,et al.Diagnostic power of variouscomputed tomography signs in diagnosing acute appendicitis.Clin Imaging,2012,36(1):29-34.
[14]郝晶,王岚,顾淑春,等.应用高频超声诊断不同类型儿童急性阑尾炎的价值.中国妇幼保健,2014,29(36):6138-6139.
[15]NASIRI S,MOHEBBI F,SODAGARI N,et al.Diagnostic values ofultrasound and the Modified Alvarado Scoring System inacuteappendicitis.Int J Emerg Med,2012,5(1):26.
[2]李文莲,李光贵.血清前白蛋白和C-反应蛋白在儿童感染性疾病诊断中的临床意义.临床荟萃,2011,26(19):1711-1713.
[3]吴辉.C反应蛋白、白细胞计数和中性粒细胞联合检测对急性阑尾炎诊断的临床应用价值.中国实用医药,2013,8(27):62.
[4]高立学.B超辅助选择性小切口阑尾切除术治疗急性阑尾炎.现代中西医结合杂志,2011,20(16):2017-2018.
[5]LEEUWENBURGH M M,WIARDA B M,WIEZER M J,et al.Comparison ofimaging strategies with conditional contrast-enhanced CTandunenhanced MR imaging in patients suspected of havingappendicitis:a multicenter diagnostic performance.Radiology,2013,268(1):135-143.
[6]黄爱芳.超敏C反应蛋白、白细胞计数联合检测对诊断小儿急性阑尾炎的临床意义.检验医学与临床,2012,9(20):2620-2621.
[7]杨晓峰,杨新宏,刘秋霞,等.CRP、WBC、异型淋巴细胞检测在儿童感染性疾病中的应用.承德医学院学报,2012,29(2):140.
[8]袁伟华,单蕊,谷兴琳.儿童急性阑尾炎及其并发症的CT诊断价值.江苏医药,2013,39(21):2168-2619.
[9]浦晓,张奕鹏,徐建国.血清CRP测定对5岁以下儿童急性阑尾炎诊断的价值.白求恩军医学院学报,2011,9(6):封2.
[10]PARK J S,JEONG J H,LEE J I,et al.Accuracies of diagnostic methods foracute appendicitis.Am Surg,2013,79(1):101-106.
[11]MAN E,SIMONKA Z,VARGA A,et al.Impact of the Alvarado score onthe diagnosis of acute appendicitis:comparing clinical judgment,Alvarado score,and a new modified score in suspectedappendicitis:a prospective,randomized clinical trial.Surg Endosc,2014,28(8):2398-2405.
[12]寿铁军,李勇,马能强,等.穿孔性阑尾炎患儿白细胞、中性粒细胞和C反应蛋白的检测价值.现代实用医学,2011,23(6):638.
[13]LAI V,CHAN W C,LAU H Y,et al.Diagnostic power of variouscomputed tomography signs in diagnosing acute appendicitis.Clin Imaging,2012,36(1):29-34.
[14]郝晶,王岚,顾淑春,等.应用高频超声诊断不同类型儿童急性阑尾炎的价值.中国妇幼保健,2014,29(36):6138-6139.
[15]NASIRI S,MOHEBBI F,SODAGARI N,et al.Diagnostic values ofultrasound and the Modified Alvarado Scoring System inacuteappendicitis.Int J Emerg Med,2012,5(1):26.