Groselj-Grenc Mojca, Repse Stane, Vidmar Dubravka, Derganc Metka
Department of Pediatric Surgery and Intensive Care, University Medical Center, Ljubljana, Slovenia.
Croat Med J. 2007 Jun;48(3):353-61.
To compare the diagnostic accuracy of clinical examination, white blood cell and differential count, and C-reactive protein as routine tests for acute appendicitis with that of interleukin-6 (IL-6) and ultrasonography.
Eighty-two children were admitted to the Department of Pediatric Surgery and Intensive Care, Ljubljana, Slovenia because of suspected acute appendicitis. Among them, 49 children underwent surgery for acute appendicitis and 33 had abdominal pain but were not treated surgically and were diagnosed with non-specific abdominal pain or mesenteric lymphadenitis on sonography. Clinical signs of acute appendicitis were determined by surgeons on admission. White blood cell count and differential and serum concentrations of C-reactive protein and IL-6 were measured and abdominal ultrasonography was performed.
Ultrasonography showed the highest diagnostic accuracy (92.9%; 95% confidence interval [CI], 84.5%-98.0%, Bayes' theorem), followed by serum IL-6 concentration (77.6%; 67.1-86.1%, receiver-operating characteristic [ROC] curve analysis), clinical signs (69.5%; 59.5-79.0%, Bayes' theorem), white blood cell count (68.4%; 57.2-78.3%, ROC curve analysis), and serum C-reactive protein concentration (63.7%; 52.174.3%, ROC curve analysis). Ultrasonography achieved also the highest specificity (95.2%) and positive (93.8%) and negative (93.3%) predictive values, whereas clinical signs showed the highest sensitivity (93.9%).
Ultrasonography was a more accurate diagnostic method than IL-6 serum concentration, laboratory marker with the highest diagnostic accuracy in our study, and hence it should be a part of the diagnostic procedure for acute appendicitis in children.
比较临床检查、白细胞及分类计数、C反应蛋白作为急性阑尾炎常规检查的诊断准确性与白细胞介素-6（IL-6）及超声检查的诊断准确性。
82名因疑似急性阑尾炎而入住斯洛文尼亚卢布尔雅那市儿科手术与重症监护科的儿童。其中，49名儿童接受了急性阑尾炎手术，33名有腹痛但未接受手术治疗，超声检查诊断为非特异性腹痛或肠系膜淋巴结炎。急性阑尾炎的临床体征由外科医生在入院时确定。测量白细胞计数及分类、C反应蛋白和IL-6的血清浓度，并进行腹部超声检查。
超声检查显示出最高的诊断准确性（92.9%；95%置信区间[CI]，84.5%-98.0%，贝叶斯定理），其次是血清IL-6浓度（77.6%；67.1-86.1%，受试者工作特征[ROC]曲线分析）、临床体征（69.5%；59.5-79.0%，贝叶斯定理）、白细胞计数（68.4%；57.2-78.3%，ROC曲线分析）和血清C反应蛋白浓度（63.7%；52.1-74.3%，ROC曲线分析）。超声检查还具有最高的特异性（95.2%）以及阳性（93.8%）和阴性（93.3%）预测值，而临床体征显示出最高的敏感性（93.9%）。
在我们的研究中，超声检查是比IL-6血清浓度更准确的诊断方法，IL-6血清浓度是诊断准确性最高的实验室指标，因此超声检查应成为儿童急性阑尾炎诊断程序的一部分。
