血清 C 反应蛋白、白细胞计数和中性粒细胞百分比与急性阑尾炎组织病理学发现的相关性。
Correlation of serum C-reactive protein, white blood count and neutrophil percentage with histopathology findings in acute appendicitis.
机构信息
Department of Abdominal Surgery, University Clinical Center of Kosovo, Prishtina, Kosovo.
出版信息
World J Emerg Surg. 2012 Aug 6;7(1):27. doi: 10.1186/1749-7922-7-27.
BACKGROUND
Acute appendicitis is one of the most common surgical emergencies. Accurate diagnosis of acute appendicitis is based on careful history, physical examination, laboratory and imaging investigation. The aim of the study is to analyze the role of C-reactive protein (CRP), white blood count (WBC) and Neutrophil percentage (NP) in improving the accuracy of diagnosis of acute appendicitis and to compare it with the intraoperative assessment and histopathology findings.
MATERIALS AND METHODS
This investigation was a prospective double blinded clinical study. The study was done on 173 patients surgically treated for acute appendicitis. The WBC, NP, and measurement of CRP were randomly collected pre-operatively from all involved patients. Macroscopic assessment was made from the operation. Appendectomy and a histopathology examination were performed on all patients. Gross description was compared with histopathology results and then correlated with CRP, WBC, and NP.
RESULTS
The observational accuracy was 87,3%, as compared to histopathological accuracy which was 85.5% with a total of 173 patients that were operated on. The histopathology showed 25 (14.5%) patients had normal appendices, and 148 (85.5%) patients had acutely inflamed, gangrenous, or perforated appendicitis. 52% were male and 48% were female, with the age ranging from 5 to 59 with a median of 19.7. The gangrenous type was the most frequent (52.6%). The WBC was altered in 77.5% of the cases, NP in 72.3%, and C-reactive protein in 76.9% cases. In those with positive appendicitis, the CRP and WBC values were elevated in 126 patients (72.8%), whereas NP was higher than 75% in 117 patients (67.6%). Out of 106 patients with triple positive tests, 101 (95.2%) had appendicitis. The sensitivity, specificity, and positive predictive values of the 3 tests in combination were 95.3%, 72.2%, and 95.3%, respectively.
CONCLUSION
The raised value of the CRP was directly related to the severity of inflammation (p-value <0.05). CRP monitoring enhances the diagnostic accuracy of acute appendicitis. The diagnostic accuracy of CRP is not significantly greater than WBC and NP. A combination of these three tests significantly increases the accuracy. We found that elevated serum CRP levels support the surgeon's clinical diagnosis.
背景
急性阑尾炎是最常见的外科急症之一。急性阑尾炎的准确诊断基于仔细的病史、体格检查、实验室和影像学检查。本研究的目的是分析 C 反应蛋白（CRP）、白细胞计数（WBC）和中性粒细胞百分比（NP）在提高急性阑尾炎诊断准确性方面的作用，并将其与术中评估和组织病理学发现进行比较。
材料和方法
这是一项前瞻性、双盲的临床研究。研究共纳入 173 例接受手术治疗的急性阑尾炎患者。所有患者术前均随机采集 WBC、NP 和 CRP 测量值。对所有患者进行宏观评估。对所有患者进行阑尾切除术和组织病理学检查。将大体描述与组织病理学结果进行比较，并与 CRP、WBC 和 NP 进行相关性分析。
结果
观察准确性为 87.3%，而组织病理学准确性为 85.5%，共有 173 例患者接受手术治疗。组织病理学显示 25 例（14.5%）患者阑尾正常，148 例（85.5%）患者阑尾急性炎症、坏疽或穿孔。52%为男性，48%为女性，年龄 5 至 59 岁，中位数为 19.7 岁。最常见的是坏疽性阑尾炎（52.6%）。77.5%的病例白细胞计数异常，72.3%的中性粒细胞百分比异常，76.9%的病例 C 反应蛋白异常。在阳性阑尾炎患者中，126 例（72.8%）患者 CRP 和白细胞计数升高，117 例（67.6%）患者中性粒细胞百分比高于 75%。在 106 例三联检测阳性的患者中，101 例（95.2%）患有阑尾炎。三种检测联合的灵敏度、特异性和阳性预测值分别为 95.3%、72.2%和 95.3%。
结论
CRP 值升高与炎症严重程度直接相关（p 值<0.05）。CRP 监测可提高急性阑尾炎的诊断准确性。CRP 的诊断准确性并不明显高于 WBC 和 NP。这三种检测方法的联合显著提高了准确性。我们发现，血清 CRP 水平升高支持外科医生的临床诊断。
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