Hernandez Roma, Jain Ashok, Rosiere Lucas, Henderson Sean O
Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA.
Am J Emerg Med. 2008 Mar;26(3):282-6. doi: 10.1016/j.ajem.2007.05.012.
To improve the diagnostic accuracy of identifying acute appendicitis, imaging modalities, such as ultrasound and the computed tomography scan, are used in combination with the history and physical examination. There is no reliable single laboratory marker to assist with this diagnosis. During inflammation, enterochromaffin cells in the appendix secrete serotonin, and 5-hydroxyindoleacetic acid (5-HIAA), a serotonin metabolite excreted in urine, has been found to be elevated in patients presenting with acute appendicitis.
The aim of this study was to measure the urinary 5-HIAA concentrations of patients presenting with symptoms of acute appendicitis to determine the sensitivity and specificity of urinary 5-HIAA levels for diagnosing acute appendicitis.
5-HIAA was quantitatively measured by high-performance liquid chromatography in the spot urine of 100 healthy individuals, aged 18 to 70 years, who presented to the emergency medicine department with a clinical picture of acute appendicitis. Urine concentration results were correlated to the gold standard of histopathologic reports of removed appendices. The sensitivity, specificity, and their 95% confidence intervals were derived.
Of the 100 patients presenting with symptoms consistent with acute appendicitis, 72 had appendectomies and 2 had cholecystectomies. The remaining 26 patients were discharged after hospital observation. A total of 64 patients were found to have appendicitis: 52 had acute appendicitis, whereas 12 had perforated and/or gangrenous (nonacute) appendices. The acute appendicitis group had a mean urinary 5-HIAA level of 19.31 micromol/L, slightly lower than the 23.10 micromol/L of the patients with gangrenous/perforated appendicitis. The group without appendicitis had a urinary 5-HIAA value of 17.27 micromol/L. Using the lowest of previously reported cutoffs, we calculated the sensitivity and specificity of this test for acute appendicitis as 63% and 33%, respectively.
Urinary 5-HIAA level is not a good diagnostic tool for determining acute appendicitis.
为提高急性阑尾炎的诊断准确性，超声和计算机断层扫描等成像方式与病史及体格检查联合使用。目前尚无可靠的单一实验室指标辅助该诊断。在炎症过程中，阑尾中的肠嗜铬细胞分泌血清素，而5-羟吲哚乙酸（5-HIAA）作为血清素的代谢产物经尿液排出，已发现其在急性阑尾炎患者中升高。
本研究旨在测量出现急性阑尾炎症状患者的尿5-HIAA浓度，以确定尿5-HIAA水平对诊断急性阑尾炎的敏感性和特异性。
采用高效液相色谱法定量测定100名年龄在18至70岁、因急性阑尾炎临床表现就诊于急诊科的健康个体的即时尿样中的5-HIAA。尿浓度结果与切除阑尾的组织病理学报告这一金标准相关。得出敏感性、特异性及其95%置信区间。
100例表现出与急性阑尾炎相符症状的患者中，72例行阑尾切除术，2例行胆囊切除术。其余26例患者经住院观察后出院。共发现64例患者患有阑尾炎：52例为急性阑尾炎，12例为穿孔和/或坏疽性（非急性）阑尾。急性阑尾炎组尿5-HIAA平均水平为19.31微摩尔/升，略低于坏疽性/穿孔性阑尾炎患者的23.10微摩尔/升。无阑尾炎组尿5-HIAA值为17.27微摩尔/升。使用先前报道的最低临界值，我们计算出该试验对急性阑尾炎的敏感性和特异性分别为63%和33%。
尿5-HIAA水平不是诊断急性阑尾炎的良好工具。
