Dueholm S, Bagi P, Bud M
Department of Surgical Gastroenterology, Herlev Hospital, University of Copenhagen, Denmark.
Dis Colon Rectum. 1989 Oct;32(10):855-9. doi: 10.1007/BF02554555.
The diagnostic value of C-reactive protein (CRP), total white blood cell (WBC) count, total neutrophil count, and neutrophil differential count were evaluated in a prospective blinded study of 204 patients submitted with the tentative diagnosis of acute appendicitis. The laboratory tests were performed on blood samples obtained at the time of admission, and the results were stored until the patients were discharged. One hundred patients were operated on: 59 had appendicitis, 3 had other surgically correctable diseases, and 38 had a superfluous exploration. All 104 nonoperated patients recovered spontaneously. The sensitivity, specificity, and predictive values of single tests and test combinations were calculated at different cutoff levels. Using standard reference intervals, WBC count demonstrated the best sensitivity (83 percent) and predictive value of a negative result (88 percent). Combining the tests by an "or" rule enhanced the sensitivity to 100 percent, employing WBC count or CRP or neutrophil percentage above the reference range (triple test), but at the expense of the predictive value of a positive test (37 percent). It was concluded that both single tests and combined tests are of limited value in predicting acute appendicitis. However, the same triple test combination proved a predictive value of a negative result at 100 percent (95 percent confidence limits 92 to 100 percent), indicating that acute appendicitis is unlikely when these tests are simultaneously negative. The triple test combination was valid in 32 percent of the patients who were free from appendicitis. In the study group, 10 of the patients (25 percent) who had a superfluous exploration had a negative triple test, and they might have avoided surgery if it had been used. Therefore, the triple test is recommended as a help in reducing the significant rate of negative laparotomies in patients suspected of having acute appendicitis.
在一项针对204例初步诊断为急性阑尾炎患者的前瞻性盲法研究中，评估了C反应蛋白（CRP）、白细胞总数（WBC）、中性粒细胞总数及中性粒细胞分类计数的诊断价值。在患者入院时采集血样进行实验室检测，结果保存至患者出院。100例患者接受了手术：59例患有阑尾炎，3例患有其他可通过手术纠正的疾病，38例进行了不必要的探查。所有104例未手术患者均自行康复。计算了不同临界值水平下单项检测及检测组合的敏感性、特异性和预测值。采用标准参考区间时，白细胞计数显示出最佳敏感性（83%）和阴性结果预测值（88%）。通过“或”规则组合检测可将敏感性提高至100%，即白细胞计数或CRP或中性粒细胞百分比高于参考范围（三联检测），但以阳性检测的预测值为代价（37%）。得出结论，单项检测和联合检测在预测急性阑尾炎方面价值有限。然而，同样的三联检测组合显示阴性结果的预测值为100%（95%置信区间92%至100%），表明当这些检测同时为阴性时，急性阑尾炎的可能性不大。三联检测组合在32%无阑尾炎的患者中有效。在研究组中，10例进行了不必要探查的患者（25%）三联检测为阴性，如果采用该检测，他们可能避免手术。因此，推荐三联检测作为降低疑似急性阑尾炎患者阴性剖腹探查率的一种辅助手段。
