Agrawal C S, Adhikari S, Kumar M
Department of Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
Nepal Med Coll J. 2008 Mar;10(1):11-5.
Various diagnostic modalities have been reported to influence the negative appendicectomy. C-reactive protein (CRP), an acute phase reactant, may improve the accuracy of diagnosing acute appendicitis. The present study was undertaken to evaluate the utility of CRP as a diagnostic tool among patients clinically suspected to have acute appendicitis. The role of total leukocyte (WBC) count was also studied. A total of 145 diagnosed cases of acute appendicitis were studied over a period of one and half years. CRP was raised in 91 cases and was normal in 54 cases. The sensitivity and specificity of CRP estimation in diagnosing appendicitis was 74.8% and 66.7% respectively and the sensitivity and specificity for total WBC count was 78.6 and 54.8% respectively. The present study suggests that we cannot rely wholly on CRP or on WBC count for operative decision. Clinical judgment is still the best modality for the diagnosis and operative management of acute appendicitis. It seems wiser to use active observation, which should identify most patients with non-specific pain and reserve operation for those who need it most.
据报道，多种诊断方式会影响阴性阑尾切除术。C反应蛋白（CRP）作为一种急性期反应物，可能会提高急性阑尾炎诊断的准确性。本研究旨在评估CRP在临床疑似患有急性阑尾炎患者中作为诊断工具的效用。同时也研究了白细胞（WBC）计数的作用。在一年半的时间里，共研究了145例确诊的急性阑尾炎病例。91例患者CRP升高，54例患者CRP正常。CRP评估诊断阑尾炎的敏感性和特异性分别为74.8%和66.7%，白细胞总数的敏感性和特异性分别为78.6%和54.8%。本研究表明，我们不能完全依靠CRP或白细胞计数来做出手术决策。临床判断仍然是急性阑尾炎诊断和手术治疗的最佳方式。采用积极观察似乎更为明智，这应该能识别出大多数有非特异性疼痛的患者，并为最需要手术的患者保留手术治疗。
