Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, OH, USA.
Acad Emerg Med. 2011 Jul;18(7):686-91. doi: 10.1111/j.1553-2712.2011.01108.x.
Lower abdominal pain is a common complaint in girls and young women presenting to a pediatric emergency department (PED). An extensive evaluation may be required to exclude surgical emergencies such as appendicitis and ovarian torsion. However, clinicians and families prefer to limit invasive procedures and radiation exposure. The literature suggests that serum biomarkers such as the cytokine interleukin-6 (IL-6) can predict ovarian torsion in adults, while the membrane glycoprotein cluster of differentiation-64 (CD64) has been linked with bacterial infections and sepsis. Therefore, the study objective was to assess whether plasma IL-6 or neutrophil CD64 surface levels would assist clinicians in distinguishing surgical diagnoses (ovarian torsion and appendicitis) from nonsurgical diagnoses in young females with lower abdominal pain.
This study was a prospective, cross-sectional, pilot study of young females presenting with lower abdominal pain. Demographics, clinical and laboratory data, and final diagnoses were recorded. Plasma IL-6 and neutrophil CD64 were quantified. Nonparametric Kruskal-Wallis test was used to detect significant differences in IL-6 and CD64 values between surgical and nonsurgical patients. Further analysis was done to detect differences among the surgical patients (appendicitis vs. ovarian torsion). A bivariate analysis using the Wilcoxon rank sum was used to test for significant differences in IL-6 and CD64 by selected clinical factors.
There were 112 female subjects ages 6 to 21 years enrolled. Final diagnoses were grouped as appendicitis (n = 38, 34%), ovarian torsion (n = 15, 13%), and nonsurgical (n = 59, 53%). Surgical cases had significantly higher levels of IL-6 compared to nonsurgical cases (p < 0.0001), and appendicitis patients had significantly higher CD64 indexes compared to ovarian torsion patients (p = 0.007). The clinical characteristics of fever of ≥38°C (p = 0.0002) and constant pain (p = 0.02) were significantly associated with elevated IL-6. Fever of ≥38°C (p = 0.02) was significantly associated with a higher CD64 index.
Interleukin-6 was significantly elevated in surgical patients compared to nonsurgical patients in this sample of young females, and CD64 was significantly elevated in appendicitis patients compared to ovarian torsion patients. These data suggest that with larger sample sizes and future confirmatory studies, these biomarkers may be useful in the evaluation of young women with lower quadrant abdominal pain.
下腹痛是儿科急诊（PED）就诊女孩和年轻女性的常见主诉。为了排除阑尾炎和卵巢扭转等外科急症，可能需要进行广泛的评估。然而，临床医生和患者家属更倾向于限制有创操作和辐射暴露。文献表明，细胞因子白细胞介素-6（IL-6）等血清生物标志物可预测成人卵巢扭转，而膜糖蛋白分化抗原 64（CD64）与细菌感染和脓毒症有关。因此，本研究旨在评估血浆 IL-6 或中性粒细胞 CD64 表面水平是否有助于临床医生区分年轻女性下腹痛的外科诊断（卵巢扭转和阑尾炎）和非外科诊断。
本研究为前瞻性、横断面、初步研究，纳入了下腹痛就诊的年轻女性。记录了人口统计学、临床和实验室数据以及最终诊断。定量检测了血浆 IL-6 和中性粒细胞 CD64。采用非参数 Kruskal-Wallis 检验检测手术和非手术患者之间 IL-6 和 CD64 值的显著差异。进一步的分析旨在检测手术患者（阑尾炎与卵巢扭转）之间的差异。采用 Wilcoxon 秩和检验对选择的临床因素对 IL-6 和 CD64 的差异进行双变量分析。
共纳入 112 名 6 至 21 岁的女性患者。最终诊断分为阑尾炎（n=38，34%）、卵巢扭转（n=15，13%）和非手术（n=59，53%）。手术组的 IL-6 水平明显高于非手术组（p<0.0001），阑尾炎患者的 CD64 指数明显高于卵巢扭转患者（p=0.007）。发热≥38°C（p=0.0002）和持续性疼痛（p=0.02）的临床特征与 IL-6 升高显著相关。发热≥38°C（p=0.02）与 CD64 指数升高显著相关。
在本研究中，与非手术组相比，手术组年轻女性的 IL-6 明显升高，与卵巢扭转组相比，阑尾炎患者的 CD64 明显升高。这些数据表明，随着样本量的增加和未来的验证性研究，这些生物标志物可能有助于评估年轻女性的下腹痛。
