Mäkelä Jyrki T, Klintrup Kai, Rautio Tero
Center of Surgical Research, Medical Research Center, Oulu University Hospital, University of Oulu, Kajaanintie 50, 90220, Oulu, Finland.
Int J Colorectal Dis. 2016 Jan;31(1):23-7. doi: 10.1007/s00384-015-2410-8. Epub 2015 Oct 31.
Computed tomography (CT) is the most appropriate imaging modality for the assessment of acute diverticulitis at the emergency unit. The aim of this study was to determine the clinical outcome of the patients presented first time with symptoms of acute diverticulitis and low CRP values.
Two-hundred patients, who presented with the symptoms of acute diverticulitis and had CRP values under 150 mg/L, underwent abdominal CT examination on admission to Oulu University Hospital. The clinical parameters and radiological findings were compared in relation to clinical outcome both by means of univariate and multivariate analyses.
Seventy-one (35.5 %) of the 200 patients presented on admission with complicated diverticulitis. CRP values between 100 and 150 mg/L predicted complicated disease, but the mean values of CRP between uncomplicated disease, 89 mg/L ± 39, and complicated disease, 101 mg/L ± 39, did not differ significantly. Free intra-abdominal fluid in CT was the only independent risk factor of the need for interventional therapy and treatment in the intensive care unit. Longevity of the patients and free fluid in CT predicted significantly prolonged hospitalization. Mortality was 1 % and older patients were significantly affected. The recurrence rate of acute diverticulitis was 24 % (43/177) in the whole group and 18 % (23/129) after uncomplicated diverticulitis.
Low CRP values do not reliably predict uncomplicated disease in patients presented first time at the emergency unit with acute diverticulitis. We recommend that the need for abdominal CT is carefully evaluated according to the patient's clinical status, always even when the CRP value is under 150 mg/L.
计算机断层扫描（CT）是急诊科评估急性憩室炎最合适的成像方式。本研究的目的是确定首次出现急性憩室炎症状且C反应蛋白（CRP）值较低的患者的临床结局。
200例出现急性憩室炎症状且CRP值低于150mg/L的患者在奥卢大学医院入院时接受了腹部CT检查。通过单因素和多因素分析比较了临床参数和影像学检查结果与临床结局的关系。
200例患者中有71例（35.5%）入院时表现为复杂性憩室炎。CRP值在100至150mg/L之间预示着疾病复杂，但单纯性疾病组的CRP平均值为89mg/L±39，复杂性疾病组为101mg/L±39，两者差异无统计学意义。CT显示腹腔内游离液体是需要介入治疗和入住重症监护病房治疗的唯一独立危险因素。患者的寿命和CT显示的游离液体预示住院时间显著延长。死亡率为1%，老年患者受影响显著。全组急性憩室炎复发率为24%（43/177），单纯性憩室炎后复发率为18%（23/129）。
对于首次在急诊科出现急性憩室炎的患者，低CRP值不能可靠地预测单纯性疾病。我们建议根据患者的临床状况仔细评估是否需要进行腹部CT检查，即使CRP值低于150mg/L时也应如此。
