Ambe Peter C, Orth Valerie, Gödde Daniel, Zirngibl Hubert
Department of Surgery HELIOS Universitätsklinikum Wuppertal Witten-Herdecke University Heusnerstr. Wuppertal, Germany.
Institute of Pathology and Molecular Pathology HELIOS Universitätsklinikum Wuppertal Witten-Herdecke University Heusnerstr. Wuppertal, Germany.
PLoS One. 2016 Dec 29;11(12):e0168769. doi: 10.1371/journal.pone.0168769. eCollection 2016.
Is the patient really suffering from acute appendicitis? Right lower quadrant pain is the most common sign of acute appendicitis. However, many other bowels pathologies might mimic acute appendicitis. Due to fear of the consequences of delayed or missed diagnosis, the indication for emergency appendectomy is liberally made. This has been shown to be associated with high rates of negative appendectomy with risk of potentially serious or lethal complications. Thus there is need for a better preoperative screening of patients with suspected appendicitis.
This prospective single center single-blinded pilot study was conducted in the Department of surgery at the HELIOS Universitätsklinikum Wuppertal, Germany. Calprotectin was measured in pre-therapeutic stool samples of patients presenting in the emergency department with pain to the right lower quadrant. Fecal calprotectin (FC) values were analyzed using commercially available ELISA kits. Cut-off values for FC were studied using the receiver-operator characteristic (ROC) curve. The Area under the curve (AUC) was reported for each ROC curve.
The mean FC value was 51.4 ± 118.8 μg/g in patients with AA, 320.9 ± 416.6 μg/g in patients with infectious enteritis and 24.8 ± 27.4 μg/g in the control group. ROC curve showed a close to 80% specificity and sensitivity of FC for AA at a cut-off value of 51 μg/g, AUC = 0.7. The sensitivity of FC at this cut-off value is zero for enteritis with a specificity of 35%.
Fecal calprotectin could be helpful in screening patients with pain to the right lower quadrant for the presence of acute appendicitis or infectious enteritis with the aim of facilitating clinical decision-making and reducing the rate of negative appendectomy.
患者真的患有急性阑尾炎吗？右下腹疼痛是急性阑尾炎最常见的症状。然而，许多其他肠道疾病可能会模仿急性阑尾炎。由于担心延迟或漏诊的后果，急诊阑尾切除术的指征被广泛应用。这已被证明与高比例的阴性阑尾切除术相关，存在潜在严重或致命并发症的风险。因此，需要对疑似阑尾炎患者进行更好的术前筛查。
这项前瞻性单中心单盲试验研究在德国伍珀塔尔市黑利奥斯大学医院外科进行。对急诊科出现右下腹疼痛的患者治疗前的粪便样本进行钙卫蛋白检测。使用市售酶联免疫吸附测定（ELISA）试剂盒分析粪便钙卫蛋白（FC）值。使用受试者工作特征（ROC）曲线研究FC的临界值。报告每条ROC曲线下的面积（AUC）。
急性阑尾炎患者的平均FC值为51.4±118.8μg/g，感染性肠炎患者为320.9±416.6μg/g，对照组为24.8±27.4μg/g。ROC曲线显示，FC对急性阑尾炎的特异性和敏感性在临界值为51μg/g时接近80%，AUC = 0.7。在此临界值下，FC对肠炎的敏感性为零，特异性为35%。
粪便钙卫蛋白有助于筛查右下腹疼痛的患者是否患有急性阑尾炎或感染性肠炎，以促进临床决策并降低阴性阑尾切除术的发生率。
