Third Department of General Surgery, Jagiellonian University, Medical College, Krakow, Poland.
Langenbecks Arch Surg. 2010 Nov;395(8):1061-8. doi: 10.1007/s00423-009-0565-x. Epub 2009 Nov 19.
Determining the optimum algorithm for diagnostic procedure in suspected acute appendicitis (AA) may not only reduce the number of unnecessary operations, but also the frequency of complications, and may contribute measurably to reducing the costs of treating patients with acute abdominal conditions.
The aim of the study was to assess the value of standard diagnostic methods and measurement of selected biochemical and hematological parameters (C-reactive protein, CRP; interleukin-6, IL-6; procalcitonin, PCT; total count of white blood cell, WBC) in the accuracy of preoperative AA diagnosis.
The prospective study included 132 patients (female: 52.3%, male: 47.7%) emergency admitted to the Surgical Department, aged 15 to 74 years (mean 36 years), with a suspicion of appendicitis. Measurement of PCT concentration was carried out by immunoluminometric assay, IL-6 concentration by micro enzyme-linked immunosorbent assay and CRP concentration by immunonephelometric assay. Statistical analysis was done by the chi-square test and Fisher's exact test for categorized discrete variables, and the Mann-Whitney U and Kruskal-Wallis tests for continuous variables. In order to assay the diagnostic utility of tests, the receiver operating characteristic model of curve analysis was used.
AA was confirmed in 89 (67.5%) of the patients operated on (group A). Twenty-six (19.7%) of the patients were not operated on and did not require surgery (group C); in 13 patients (9.8%) operated with a preliminary diagnosis of AA, no changes in the appendix were found during the course of the operation (group B). Four (3%) of the patients treated conservatively for periappendicular infiltration were excluded from the following analysis (group D). The mean count of WBC in AA was 13.22 ± 4.45 × 103/μL, with no statistical significance between groups, which does not allow the patients requiring surgery to be distinguished. The highest elevation of IL-6 concentration was observed in the group with the AA and the periappendicular infiltration: 101.5 ± 355.9 vs. 173.6 ± 228.33 pg/mL, respectively; p < 0.05. No surgery patients of group C showed considerably lower CRP concentrations than those of group D: CRP: 2.05 ± 3.6 vs. 6.36 ± 4.74 mg/L; p < 0.05. In cases of advanced forms of AA, the gangrenous with perforation, higher marker values are obtained than those in the phlegmonose form (186.60 ± 541.2 vs. 40.08 ± 48.3 pg/mL; (p < 0.05) for IL-6 and 8.88 ± 7.45 vs. 2.84 ± 3.83 mg/L; (p < 0.001) for CRP, respectively).
确定疑似急性阑尾炎（AA）的诊断程序的最佳算法不仅可以减少不必要的手术数量，还可以降低并发症的发生率，并可以显著降低治疗急性腹痛患者的成本。
本研究旨在评估标准诊断方法和测量选定的生化和血液学参数（C 反应蛋白，CRP；白细胞介素 6，IL-6；降钙素原，PCT；白细胞总数，WBC）在术前 AA 诊断准确性中的价值。
前瞻性研究包括 132 名（女性：52.3%，男性：47.7%）急诊入外科的患者，年龄 15 至 74 岁（平均 36 岁），怀疑患有阑尾炎。PCT 浓度的测量通过免疫发光测定法进行，IL-6 浓度通过微量酶联免疫吸附测定法进行，CRP 浓度通过免疫比浊法进行。使用卡方检验和 Fisher 确切检验对分类离散变量进行统计分析，使用 Mann-Whitney U 和 Kruskal-Wallis 检验对连续变量进行分析。为了检测测试的诊断效用，使用了接收器工作特征曲线分析模型。
在接受手术的 89 名（67.5%）患者中证实了 AA（组 A）。26 名（19.7%）患者未接受手术且无需手术（组 C）；在初步诊断为 AA 的 13 名患者中，手术过程中未发现阑尾有变化（组 B）。4 名（3%）接受阑尾周围浸润保守治疗的患者被排除在以下分析之外（组 D）。AA 患者的平均白细胞计数为 13.22 ± 4.45 × 103/μL，组间无统计学差异，无法区分需要手术的患者。IL-6 浓度升高最高的是 AA 和阑尾周围浸润组：分别为 101.5 ± 355.9 和 173.6 ± 228.33 pg/mL；p<0.05。不需要手术的组 C 患者的 CRP 浓度明显低于组 D：CRP：2.05 ± 3.6 与 6.36 ± 4.74 mg/L；p<0.05。在 AA 的晚期形式，坏疽伴穿孔的情况下，获得的标志物值高于脓性形式（186.60 ± 541.2 与 40.08 ± 48.3 pg/mL；（p<0.05）和 IL-6，8.88 ± 7.45 与 2.84 ± 3.83 mg/L；（p<0.001）CRP，分别）。
