Mekhail Peter, Naguib Nader, Yanni Fady, Izzidien Asal
Department of Surgery, Aintree University Hospital, Liverpool, United Kingdom.
Afr J Paediatr Surg. 2011 Sep-Dec;8(3):309-12. doi: 10.4103/0189-6725.91676.
Clinical diagnosis of appendicitis can be challenging, particularly in the paediatric age group. There is an increased risk of perforation in paediatrics; therefore, a need for sensitive and specific diagnostic tool is mandatory.
The aim of this study is to evaluate the role of preoperative inflammatory markers in supporting the clinical diagnosis of appendicitis in the paediatric age group.
Retrospective study of 268 emergency paediatric appendicectomies performed in a District General Hospital in Wales, over a period of seven years (2002-2009). The data collected from hospital database include preoperative inflammatory markers, C-reactive protein (CRP) and white blood cells count (WBCC) and post-operative histology. Statistical analysis was performed using Fisher's exact test.
The median age group in the study was 12 (2-16). 141 (53%) patients were <12 years, while 127 (47%) patients were 12-16 years old. Male : female ratio = 1 : 1 (134 each). Inflammatory markers were not done for 94 patients (35%). CRP was done for 149 cases (55.6%), while WBCC was done for 172 cases (64%). Both markers were done together for 147 cases (54.8%). Histology was positive (inflamed / gangrenous appendix) in 202 cases (75.4%). Eight cases were associated with Enterobious vermicularis infestation and one patient had carcinoid tumour. The sensitivity and specificity of CRP were 82% and 60%, respectively, with positive predictive value (PPV) of 87% (P<0.0001), while those of WBCC were 80% and 59%, respectively, with PPV of 88% (P<0.0001). The sensitivity and specificity of both markers together were 80% and 70%, respectively, with PPV= 81% (P = 3.11E-8). 94 patients (35%) had an appendicectomy operation based on clinical diagnosis alone without preoperative inflammatory markers having been tested. In 28 cases (30%) out of these, postoperative histology revealed normal appendix (P = 0.18).
CRP and WBCC are simple tests that can provide a significant role supporting the clinical diagnosis of acute appendicitis in the paediatric age group.
阑尾炎的临床诊断可能具有挑战性，尤其是在儿童年龄组中。儿科患者发生穿孔的风险增加；因此，需要一种敏感且特异的诊断工具。
本研究的目的是评估术前炎症标志物在支持儿童年龄组阑尾炎临床诊断中的作用。
对威尔士一家地区综合医院在7年期间（2002 - 2009年）进行的268例儿科急诊阑尾切除术进行回顾性研究。从医院数据库收集的数据包括术前炎症标志物、C反应蛋白（CRP）和白细胞计数（WBCC）以及术后组织学检查结果。使用Fisher精确检验进行统计分析。
研究中的中位年龄组为12岁（2 - 16岁）。141例（53%）患者年龄<12岁，而127例（47%）患者年龄在12 - 16岁。男女比例为1:1（各134例）。94例患者（35%）未进行炎症标志物检测。149例（55.6%）进行了CRP检测，172例（64%）进行了WBCC检测。147例（54.8%）同时进行了两种标志物检测。组织学检查阳性（阑尾发炎/坏疽）的有202例（75.4%）。8例与蛲虫感染有关，1例患者患有类癌肿瘤。CRP的敏感性和特异性分别为82%和60%，阳性预测值（PPV）为87%（P<0.0001），而WBCC的敏感性和特异性分别为80%和59%，PPV为88%（P<0.0001）。两种标志物联合检测的敏感性和特异性分别为80%和70%，PPV = 81%（P = 3.11E - 8）。94例患者（35%）仅基于临床诊断进行了阑尾切除术，未检测术前炎症标志物。其中28例（30%）术后组织学检查显示阑尾正常（P = 0.18）。
CRP和WBCC是简单的检测方法，在支持儿童年龄组急性阑尾炎的临床诊断中可发挥重要作用。
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