Yang Horng-Ren, Wang Yu-Chun, Chung Ping-Kuei, Chen Wei-Kung, Jeng Long-Bin, Chen Ray-Jade
Department of Surgery, China Medical University Hospital, No. 2 Yuh-Der Road, Taichung 404, Taiwan.
ANZ J Surg. 2006 Jan-Feb;76(1-2):71-4. doi: 10.1111/j.1445-2197.2006.03645.x.
Laboratory measurements such as leucocyte count, neutrophil percentage and C-reactive protein (CRP) concentration are commonly used as diagnostic aids in patients with suspected acute appendicitis. The present study aimed to clarify the role of these laboratory tests in diagnosing acute appendicitis.
The medical records of 897 patients who underwent appendicectomy for suspected acute appendicitis during a 30-month period were retrospectively reviewed. The laboratory findings were correlated with the histopathology of the excised appendices. Data were analysed to calculate the sensitivity and specificity of the individual tests, as well as the test combinations.
Histologically verified appendicitis was found in 740 of the 897 patients (82.5%). The rise in leucocyte count and neutrophil percentage correlated with the degree of appendiceal inflammation. The median CRP level was much higher in the patients with ruptured appendicitis compared with that in patients with a normal appendix (96.8 vs 39.6 mg/L, P < 0.001). However, patients with uncomplicated appendicitis had a lower median CRP concentration than those with a normal appendix, although the difference was not statistically significant (24.1 vs 39.6 mg/L, P = 0.079). The sensitivity of leucocyte count, neutrophil percentage and CRP in diagnosing acute appendicitis was 85.8, 87.2 and 76.5%, respectively, whereas the specificity was 31.9, 33.1 and 26.1%, respectively. Of the 740 patients with acute appendicitis, only six had all three tests simultaneously within the reference interval.
Abnormal laboratory findings cannot reliably deliver a diagnosis of acute appendicitis. However, acute appendicitis is very unlikely when leucocyte count, neutrophil percentage and CRP level are simultaneously normal.
白细胞计数、中性粒细胞百分比和C反应蛋白（CRP）浓度等实验室检测常用于疑似急性阑尾炎患者的诊断辅助。本研究旨在阐明这些实验室检测在诊断急性阑尾炎中的作用。
回顾性分析897例在30个月期间因疑似急性阑尾炎接受阑尾切除术患者的病历。将实验室检查结果与切除阑尾的组织病理学结果进行关联。分析数据以计算各项检测以及检测组合的敏感性和特异性。
897例患者中有740例（82.5%）经组织学证实为阑尾炎。白细胞计数和中性粒细胞百分比的升高与阑尾炎症程度相关。与阑尾正常的患者相比，阑尾破裂患者的CRP中位数水平要高得多（96.8对39.6mg/L，P<0.001）。然而，单纯性阑尾炎患者的CRP中位数浓度低于阑尾正常的患者，尽管差异无统计学意义（24.1对39.6mg/L，P=0.079）。白细胞计数、中性粒细胞百分比和CRP诊断急性阑尾炎的敏感性分别为85.8%、87.2%和76.5%，而特异性分别为31.9%、33.1%和26.1%。在740例急性阑尾炎患者中，只有6例三项检测结果同时在参考区间内。
异常的实验室检查结果不能可靠地诊断急性阑尾炎。然而，当白细胞计数、中性粒细胞百分比和CRP水平同时正常时，急性阑尾炎的可能性极小。
