Doehn C, Fornara P, Kausch I, Büttner H, Friedrich H J, Jocham D
Department of Urology, (Head: Prof. Dr. D. Jocham), Medical University of Lübeck, Germany.
Eur Urol. 2001 Feb;39(2):215-21. doi: 10.1159/000052439.
The evaluation of patients with an acute scrotum is primarily based on physical examination, imaging studies, as well as blood and urine tests. However, the differential diagnosis may be difficult in some cases. In a retrospective study, we investigated the value of acutephase proteins in serum and plasma from patients with an acute scrotum.
A total of 104 patients (epididymitis n=52, testicular tumor n=17, testicular torsion n = 11, other conditions n = 24) with an acute scrotum were included in this study. In all patients the acute-phase proteins C-reactive protein (CRP), haptoglobin, alpha1-acid glycoprotein and transferrin in serum as well as fibrinogen in plasma were determined by turbidimetric analysis. The results were compared to the clinical findings, routine blood and urine tests and ultrasound.
Patients with an epididymitis showed at least a 4-fold elevation of CRP except for 2 cases (median 63.2 mg/l). In these patients, the sensitivity of CRP was 96.2%, the specificity 94.2%, the negative predictive value 94.2% and the positive predictive value 94.3%. Patients with a testicular tumor had no significant elevation of CRP (median 9 mg/l) as well as those with a testicular torsion (median 5 mg/l) except for 1 patient. The difference between patients with epididymitis and those with noninflammatory conditions was statistically significant (p<0.001, Kruskal-Wallis test and Tukey-Kramer test). The remaining parameters (haptoglobin, fibrinogen, a1-acid glycoprotein, transferrin, white blood count, body temperature and ultrasound) were less sensitive and specific.
Acute-phase proteins (especially C-reactive protein) are helpful in differentiating epididymitis from noninflammatory conditions like testicular torsion or tumor. Turbidimetric analysis of these proteins is rapid, easy and inexpensive.
对急性阴囊患者的评估主要基于体格检查、影像学检查以及血液和尿液检查。然而，在某些情况下鉴别诊断可能会很困难。在一项回顾性研究中，我们调查了急性阴囊患者血清和血浆中急性期蛋白的价值。
本研究纳入了104例急性阴囊患者（附睾炎52例、睾丸肿瘤17例、睾丸扭转11例、其他情况24例）。对所有患者采用比浊法测定血清中的急性期蛋白C反应蛋白（CRP）、触珠蛋白、α1-酸性糖蛋白和转铁蛋白以及血浆中的纤维蛋白原。将结果与临床发现、常规血液和尿液检查以及超声检查结果进行比较。
除2例患者外，附睾炎患者的CRP至少升高了4倍（中位数为63.2mg/l）。在这些患者中，CRP的敏感性为96.2%，特异性为94.2%，阴性预测值为94.2%，阳性预测值为94.3%。睾丸肿瘤患者的CRP无显著升高（中位数为9mg/l），睾丸扭转患者除1例患者外也无显著升高（中位数为5mg/l）。附睾炎患者与非炎症性疾病患者之间的差异具有统计学意义（p<0.001，Kruskal-Wallis检验和Tukey-Kramer检验）。其余参数（触珠蛋白、纤维蛋白原、α1-酸性糖蛋白、转铁蛋白、白细胞计数、体温和超声）的敏感性和特异性较低。
急性期蛋白（尤其是C反应蛋白）有助于将附睾炎与睾丸扭转或肿瘤等非炎症性疾病区分开来。对这些蛋白进行比浊分析快速、简便且成本低廉。
