Bosak Versic Ana, Glavan Nedeljka, Bukvic Nado, Tomasic Zlatko, Nikolic Harry
Pediatric Surgery Clinic, University Hospital Center Rijeka, Rijeka, Croatia.
Emerg Med J. 2016 Dec;33(12):848-852. doi: 10.1136/emermed-2015-205559. Epub 2016 Jul 27.
Acute appendicitis is the most common abdominal surgical emergency in children, and appendectomy is the most frequent acute abdominal operation. Prompt diagnosis and surgical treatment are required to reduce the risk of perforation and prevent complications, especially in small children. Enterochromaffin cells that contain large amounts of serotonin are mostly located in the distal appendix. Serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) could therefore be a marker for acute appendicitis.
We tested urinary 5-HIAA concentrations in spot urine samples from children with acute appendicitis.
We enrolled 93 patients who underwent surgery for suspicion of acute appendicitis. The diagnosis was made intraoperatively and confirmed histopathologically. Additionally, urine samples from 102 healthy children were collected as controls. Their 5-HIAA was measured using high-performance liquid chromatography.
Acute appendicitis was diagnosed in 81 patients, whereas there were other explanations for abdominal pain in the remaining 12 patients in the non-appendicitis group. The control group comprised 102 healthy children. Considering the median of all measured 5-HIAA values as the cut-off, we analysed the proportions of patients with elevated values in all the groups. Our analysis showed that statistically there was no significant difference in the distribution of percentages among the groups. The area under the curve for 5-HIAA was 0.55 (95% CI 0.47 to 0.62) with sensitivity and specificity 60.4% and 48.9%, respectively.
Urine 5-HIAA concentration measured in spot samples is not a reliable method for diagnosing acute appendicitis in children.
急性阑尾炎是儿童最常见的腹部外科急症，阑尾切除术是最常见的急性腹部手术。需要及时诊断并进行手术治疗以降低穿孔风险并预防并发症，尤其是在幼儿中。含有大量血清素的肠嗜铬细胞大多位于阑尾远端。因此，血清素代谢物5-羟吲哚乙酸（5-HIAA）可能是急性阑尾炎的一个标志物。
我们检测了急性阑尾炎患儿即时尿样中的尿5-HIAA浓度。
我们纳入了93例因怀疑急性阑尾炎而接受手术的患者。术中做出诊断，并经组织病理学证实。此外，收集了102名健康儿童的尿样作为对照。使用高效液相色谱法测量他们的5-HIAA。
81例患者被诊断为急性阑尾炎，而非阑尾炎组中其余12例患者的腹痛有其他原因。对照组包括102名健康儿童。将所有测量的5-HIAA值的中位数作为临界值，我们分析了所有组中值升高的患者比例。我们的分析表明，各组之间百分比分布在统计学上没有显著差异。5-HIAA的曲线下面积为0.55（95%CI 0.47至0.62），敏感性和特异性分别为60.4%和48.9%。
即时尿样中测量的尿5-HIAA浓度不是诊断儿童急性阑尾炎的可靠方法。
