D-二聚体联合白细胞计数、中性粒细胞百分比及C反应蛋白在鉴别单纯性……中的诊断价值

Diagnostic Value of D-Dimer Combined with WBC Count, Neutrophil Percentage and CRP in Differentiating Between Simple and.

作者信息

Bu Xiangmao, Chen Jiahong, Wan Yanzhen, Xu Lili

出版信息

Clin Lab. 2016 Sep 1;62(9):1675-1681. doi: 10.7754/Clin.Lab.2016.160122.

DOI:10.7754/Clin.Lab.2016.160122

PMID:28164589

Abstract

BACKGROUND

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).

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

摘要

背景

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。

方法

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。

结果

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%。