Míguez Concepción, Tomatis Souverbielle Cristina, Haro Ana, Guerrero Gloria, Pérez-Egido Laura, García-Gamiz Mercedes, Marañon Rafael
Pediatric Emergency Department, Hospital General Universitario Gregorio Marañón, Madrid 28007, Spain.
Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid 28007, Spain.
Am J Emerg Med. 2016 Dec;34(12):2298-2305. doi: 10.1016/j.ajem.2016.08.032. Epub 2016 Aug 16.
A delay in the diagnosis of acute appendicitis (AA), with the added complication of symptoms that mimic other self-limited causes of abdominal pain, can lead to an increase in ruptured appendices and morbimortality. None of the serum biomarkers evaluated to date have shown a predictive value for early diagnosis.
The objective of this study was to evaluate the usefulness of proadrenomedullin (MR-proADM) in the diagnosis of AA in children presenting with acute abdominal pain.
A single-center prospective observational study was conducted in 136 children who presented to the emergency department with suspected AA.
Forty-four (32.5%) children had AA, and 9 (20.5%) had perforated appendicitis. The mean concentration of MR-proADM was significantly higher in children with AA than in children with nonspecific abdominal pain (NAP) (0.54 nmol/L; 95% confidence interval, 0.46-0.55 and 0.37 nmol/L; 95% confidence interval, 0.35-0.40, respectively). Performance characteristics of MR-proADM alone were not optimal. However, after combining best cutoff points, the combination of a C-reactive protein level of <0.3 mg/dL and a MR-proADM level of <0.34 nmol/L showed 100% sensitivity and negative predictive value, with 61% specificity.
Although MR-proADM values are higher in children with AA than in children with nonspecific abdominal pain, these values do not help in the early diagnosis of AA. The combination of low C-reactive protein and low MR-proADM levels is useful for the identification of children with a low risk of AA.
急性阑尾炎（AA）的诊断延迟，加上症状与其他自限性腹痛原因相似的并发症，可能会导致阑尾破裂及病死率增加。迄今为止，所评估的血清生物标志物均未显示出对早期诊断的预测价值。
本研究的目的是评估前肾上腺髓质素（MR-proADM）在诊断急性腹痛儿童AA中的作用。
对136名因疑似AA就诊于急诊科的儿童进行了一项单中心前瞻性观察研究。
44名（32.5%）儿童患有AA，9名（20.5%）患有穿孔性阑尾炎。AA患儿的MR-proADM平均浓度显著高于非特异性腹痛（NAP）患儿（分别为0.54 nmol/L；95%置信区间，0.46 - 0.55和0.37 nmol/L；95%置信区间，0.35 - 0.40）。单独使用MR-proADM的诊断性能并不理想。然而，在结合最佳临界值后，C反应蛋白水平<0.3 mg/dL和MR-proADM水平<0.34 nmol/L的联合显示出100%的敏感性和阴性预测值，特异性为61%。
虽然AA患儿的MR-proADM值高于非特异性腹痛患儿，但这些值无助于AA的早期诊断。低C反应蛋白和低MR-proADM水平的联合有助于识别AA低风险患儿。
