Alder Adam C, Fomby Thomas B, Woodward Wayne A, Haley Robert W, Sarosi George, Livingston Edward H
University of Texas Southwestern Medical Center, Dallas, 75390-9156, USA.
Arch Surg. 2010 Jan;145(1):63-71. doi: 10.1001/archsurg.2009.250.
What causes appendicitis is not known; however, studies have suggested a relationship between viral diseases and appendicitis. Building on evidence of cyclic patterns of appendicitis with apparent outbreaks consistent with an infectious etiology, we hypothesized that there is a relationship between population rates of appendicitis and several infectious diseases.
Epidemiologic study.
The National Hospital Discharge Survey
Estimated US hospitalized population.
International Classification of Diseases, Ninth Revision, Clinical Modification discharge diagnosis codes of the National Hospital Discharge Survey were queried from 1970 to 2006 to identify admissions for appendicitis, influenza, rotavirus, and enteric infections. Cointegration analysis of time series data was used to determine if the disease incidence trends for these various disease entities varied over time together.
Rates of influenza and nonperforating appendicitis declined progressively from the late 1970s to 1995 and rose thereafter, but influenza rates exhibited more distinct seasonal variation than appendicitis rates. Rotavirus infection showed no association with the incidence of nonperforating appendicitis. Perforating appendicitis showed a dissimilar trend to both nonperforating appendicitis and viral infection. Hospital admissions for enteric infections substantially increased over the years but were not related to appendicitis cases.
Neither influenza nor rotavirus are likely proximate causes of appendicitis given the lack of a seasonal relationship between these disease entities. However, because of significant cointegration between the annual incidence rates of influenza and nonperforated appendicitis, it is possible that these diseases share common etiologic determinates, pathogenetic mechanisms, or environmental factors that similarly affect their incidence.
阑尾炎的病因尚不清楚；然而，研究表明病毒性疾病与阑尾炎之间存在关联。基于阑尾炎呈周期性发作且发作情况与感染性病因相符的证据，我们推测阑尾炎的发病率与几种传染病之间存在关联。
流行病学研究。
国家医院出院调查
美国住院人口估计数。
查询1970年至2006年国家医院出院调查的《国际疾病分类，第九次修订本，临床修订版》出院诊断编码，以确定阑尾炎、流感、轮状病毒和肠道感染的住院情况。采用时间序列数据的协整分析来确定这些不同疾病实体的发病率趋势是否随时间共同变化。
从20世纪70年代末到1995年，流感和非穿孔性阑尾炎的发病率逐渐下降，此后上升，但流感发病率的季节性变化比阑尾炎发病率更为明显。轮状病毒感染与非穿孔性阑尾炎的发病率无关。穿孔性阑尾炎的趋势与非穿孔性阑尾炎和病毒感染均不同。多年来肠道感染的住院人数大幅增加，但与阑尾炎病例无关。
鉴于这些疾病实体之间缺乏季节性关系，流感和轮状病毒都不太可能是阑尾炎的直接病因。然而，由于流感和非穿孔性阑尾炎的年发病率之间存在显著的协整关系，这些疾病有可能共享相似的病因决定因素、发病机制或环境因素，从而同样影响它们的发病率。
