Khan M N, Davie E, Irshad K
Department of General Surgery, Wishaw General Hospital, Wishaw, Lanarkshire, UK.
J Ayub Med Coll Abbottabad. 2004 Jul-Sep;16(3):17-9.
Despite recent advances in diagnostic medicine, the diagnosis of appendicitis is still doubtful in a number of cases. Majority of the clinicians rely on their clinical examination strengthened by the laboratory tests. This study was carried out to find out the specificity and sensitivity of white cell count (WCC) and C-Reactive Protein (CRP) in diagnosing appendicitis in patients presenting with right iliac fossa pain.
A total of 259 patients were included in this study that presented in the hospital with acute right iliac fossa pain and later on operated and had appendicectomy. The histopathology data was collected to find out the frequency of negative appendicectomy. According to the histopathology reports these patients were grouped into three sub-groups as normal appendix, inflamed appendix or perforated/gangrenous appendix. A record was kept of the WCC and CRP levels of these patients on admission.
A total of 259 patients were included in this study and out of them 37 had a normal appendix giving an over all negative appendicectomy rate of 14.3%. Out of these 11 were male and 26 were female, male to female ratio being 1:2.3. The age range was 12-73 with a median age of 24. Among the 222 patients who had appendicitis, 96 had a ruptured/perforated appendix and 126 had an inflamed appendix. Over all the WCC was elevated in 185 patients and CRP was elevated in 168 cases. The cut off value for white cell count was 11 x 10(6)/L. The C reactive protein levels were calculated by immunoturbidimetric test and the cut off value was taken as 1.7 mg/dl. The sensitivity and specificity of WCC in this study was 83% and 62.1% and that for CRP was 75.6% and 83.7 %.
Both the inflammatory markers i.e. WCC and C-reactive protein can be helpful in the diagnosis, when measured together as this increases their positive predictive value.
尽管诊断医学最近取得了进展，但在许多病例中阑尾炎的诊断仍存在疑问。大多数临床医生依靠临床检查并辅以实验室检查。本研究旨在找出白细胞计数（WCC）和C反应蛋白（CRP）在诊断右下腹疼痛患者阑尾炎时的特异性和敏感性。
本研究共纳入259例因急性右下腹疼痛入院并随后接受手术切除阑尾的患者。收集组织病理学数据以确定阴性阑尾切除术的频率。根据组织病理学报告，这些患者被分为三个亚组：正常阑尾、发炎阑尾或穿孔/坏疽阑尾。记录这些患者入院时的WCC和CRP水平。
本研究共纳入259例患者，其中37例阑尾正常，总体阴性阑尾切除率为14.3%。其中男性11例，女性26例，男女比例为1:2.3。年龄范围为12 - 73岁，中位年龄为24岁。在222例患有阑尾炎的患者中，96例阑尾破裂/穿孔，126例阑尾发炎。总体而言，185例患者WCC升高，168例患者CRP升高。白细胞计数的临界值为11×10⁶/L。C反应蛋白水平通过免疫比浊法检测，临界值定为1.7mg/dl。本研究中WCC的敏感性和特异性分别为83%和62.1%，CRP的敏感性和特异性分别为75.6%和83.7%。
两种炎症标志物即WCC和C反应蛋白一起检测时对诊断有帮助，因为这会增加它们的阳性预测值。
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