Sand Michael, Bechara Falk G, Holland-Letz Tim, Sand Daniel, Mehnert Gudrun, Mann Benno
Department of General and Visceral Surgery, Augusta Krankenanstalt, Academic Teaching Hospital of the Ruhr University, Bochum, Bergstr. 26, 44791, Bochum, Germany.
Am J Surg. 2009 Aug;198(2):193-8. doi: 10.1016/j.amjsurg.2008.08.026. Epub 2009 Mar 23.
Appendiceal perforation in patients with acute appendicitis may cause a variety of potentially life-threatening complications. Escherichia coli endotoxin has been shown to impact physiological bile flow in vivo. This had led to the theory that hyperbilirubinemia in patients with appendicitis may have a predictive potential for the preoperative diagnosis of appendiceal perforation. The aim of this retrospective study was to investigate the diagnostic value of hyperbilirubinemia as a preoperative laboratory marker for appendiceal perforation in patients with acute appendicitis.
We identified 538 patients (306 female; 232 male, mean age, 35.6 y) with histologically proved acute appendicitis who underwent laparoscopic or conventional appendectomy between January 2004 and December 2007 in a surgical department of an academic teaching hospital. A retrospective multiple chart review of the medical records including laboratory values and histologic results was conducted.
The mean bilirubin level of all patients was .9 mg/dL (+/-.6 SD mg/dL; range, .1-4.3 mg/dL; median, .7 mg/dL). Patients with appendiceal perforation, however, had a mean bilirubin level of 1.5 mg/dL (+/-.9 SD mg/dL; range, .4-4.3 mg/dL; median, 1.4 mg/dL), which was significantly higher than those with a nonperforated appendicitis (P < .05). The specificity of hyperbilirubinemia for appendiceal perforation was .86 compared with .55 for white blood count and .35 for C-reactive protein. Sensitivity was .7 compared with .81 for white blood count and .96 for C-reactive protein.
Patients with hyperbilirubinemia and clinical symptoms of appendicitis should be identified as having a higher probability of appendiceal perforation than those with normal bilirubin levels.
急性阑尾炎患者的阑尾穿孔可能导致各种潜在的危及生命的并发症。大肠杆菌内毒素已被证明会影响体内生理性胆汁流动。这导致了一种理论，即阑尾炎患者的高胆红素血症可能对阑尾穿孔的术前诊断具有预测潜力。这项回顾性研究的目的是调查高胆红素血症作为急性阑尾炎患者阑尾穿孔术前实验室标志物的诊断价值。
我们确定了538例经组织学证实为急性阑尾炎的患者（女性306例；男性232例，平均年龄35.6岁），他们于2004年1月至2007年12月在一家学术教学医院的外科接受了腹腔镜或传统阑尾切除术。对包括实验室值和组织学结果在内的病历进行了回顾性多图表审查。
所有患者的平均胆红素水平为0.9mg/dL（标准差±0.6mg/dL；范围，0.1 - 4.3mg/dL；中位数，0.7mg/dL）。然而，阑尾穿孔患者的平均胆红素水平为1.5mg/dL（标准差±0.9mg/dL；范围，0.4 - 4.3mg/dL；中位数，1.4mg/dL），显著高于非穿孔性阑尾炎患者（P < 0.05）。高胆红素血症对阑尾穿孔诊断的特异性为0.86，而白细胞计数为0.55，C反应蛋白为0.35。敏感性为0.7，而白细胞计数为0.81，C反应蛋白为0.96。
与胆红素水平正常的患者相比，高胆红素血症且有阑尾炎临床症状的患者阑尾穿孔的可能性更高。
