Bu Xiangmao, Chen Jiahong, Wan Yanzhen, Xu Lili
Clin Lab. 2016 Sep 1;62(9):1675-1681. doi: 10.7754/Clin.Lab.2016.160122.
Acute appendicitis is the most common surgical emergency in pediatrics. In this study, we aimed to evaluate the diagnostic value of D-dimer in differentiating between simple and other severe acute appendicitis in children combined with white blood cell (WBC) count, neutrophil percentage, and C-reactive protein (CRP).
A retrospective study enrolled 327 consecutive patients who underwent appendectomy for acute appendicitis (aged 13 days to 14 years) in Qingdao Women & Children's Hospital from Jan 2013 to Dec 2014. WBC count, neutrophil percentage, CRP, and D-dimer levels were measured. Descriptive analyses, Student's t-test, and receiver operating characteristic (ROC) analyses were used to quantify the correlation between D-dimer level and the severity of appendicitis and to evaluate the differential diagnostic value of D-dimer combined with WBC count, neutrophil percentage and CRP between simple and other severe appendicitis.
Compared with simple appendicitis, WBC count, neutrophil percentage, CRP, and D-dimer levels were all significantly higher in other severe appendicitis (p < 0.01). Both CRP and D-dimer levels were positively correlated with the severity of disease. In differentiating between simple and other severe appendicitis, CRP (area under the ROC curve (AUC): 0.841) showed the highest sensitivity (80.7%) and the highest negative predictive value (NPV) (60.0%), while D-dimer (AUC: 0.793) showed the highest specificity (90.0%) and the highest positive predictive value (PPV) (94.9%). Combined CRP and D-dimer had a sensitivity, specificity, PPV, NPV, and accuracy of 87.5%, 94.6%, 97.8%, 72.9%, and 89.4%, respectively.
CRP and D-dimer levels are positively correlated with the severity of acute appendicitis in children. Combined CRP and D-dimer are identified as suitable diagnostic markers for differentiating between simple and other severe appendicitis, which will provide important guidance for clinicians to determine the follow-up management of acute appendicitis.
急性阑尾炎是儿科最常见的外科急症。在本研究中，我们旨在评估D - 二聚体联合白细胞（WBC）计数、中性粒细胞百分比和C反应蛋白（CRP）在鉴别儿童单纯性急性阑尾炎与其他严重急性阑尾炎中的诊断价值。
一项回顾性研究纳入了2013年1月至2014年12月期间在青岛妇女儿童医院连续接受急性阑尾炎阑尾切除术的327例患者（年龄13天至14岁）。测量了WBC计数、中性粒细胞百分比、CRP和D - 二聚体水平。采用描述性分析、学生t检验和受试者工作特征（ROC）分析来量化D - 二聚体水平与阑尾炎严重程度之间的相关性，并评估D - 二聚体联合WBC计数、中性粒细胞百分比和CRP在单纯性阑尾炎与其他严重阑尾炎之间的鉴别诊断价值。
与单纯性阑尾炎相比，其他严重阑尾炎的WBC计数、中性粒细胞百分比、CRP和D - 二聚体水平均显著更高（p < 0.01）。CRP和D - 二聚体水平均与疾病严重程度呈正相关。在鉴别单纯性阑尾炎与其他严重阑尾炎时，CRP（ROC曲线下面积（AUC）：0.841）显示出最高的敏感性（80.7%）和最高的阴性预测值（NPV）（60.0%），而D - 二聚体（AUC：0.793）显示出最高的特异性（90.0%）和最高的阳性预测值（PPV）（94.9%）。联合CRP和D - 二聚体的敏感性、特异性、PPV、NPV和准确性分别为87.5%、94.6%、97.8%、72.9%和89.4%。
CRP和D - 二聚体水平与儿童急性阑尾炎的严重程度呈正相关。联合CRP和D - 二聚体被确定为鉴别单纯性阑尾炎与其他严重阑尾炎的合适诊断标志物，这将为临床医生确定急性阑尾炎的后续管理提供重要指导。
