Motie Mohammad Reza, Nik Minoosadat Mousavi, Gharaee Malihe
M.D, Senior Lecturer, Associate Professor of Surgery, Surgical Oncology Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
M.D, Lecturer, Family Doctor, Mashhad University of Medical Sciences, Mashhad, Iran.
Electron Physician. 2017 Apr 25;9(4):4048-4054. doi: 10.19082/4048. eCollection 2017 Apr.
Clinical diagnosis of acute appendicitis still remains a problem. Delays in diagnosis of acute appendicitis may cause perforation and septic peritonitis which result in increasing morbidity and mortality. The aim of this study was to determine the sensitivity, specificity and the diagnostic value of total serum bilirubin levels as a predictor of acute appendicitis.
In this cross-sectional study, patients who underwent appendectomy with the diagnosis of acute appendicitis from April 2012 to March 2013 at Emam Reza Hospital in Mashhad (Iran) were enrolled. Serum bilirubin-Total and Direct-, were measured. Then based on the final pathologic reports, patients were categorized into five groups of normal appendix, chronic inflammatory changes, acute appendicitis, gangrenous and/or necrotic changes, and perforated appendicitis. Independent sample t-test, ANOVA, and Chi-square test were used for data analysis by SPSS version 16.
There were 174 patients studied, (117 male, 57 female) with a mean age of 27.15±0.7 years. All of the patients had rebound tenderness; 75.3% had nausea, 58.6% had anorexia and 21.3% had fever. The histological reports of all patients showed 76.4% acute appendicitis. Analyzing p-values for SGPT, SGOT, WBC was (p=0.903) and differential count was (p=0.959). The study showed no significant difference between the pathological groups. However, there were no significant differences in serum total bilirubin levels between the pathological groups. Total bilirubin showed sensitivity of 48% and specificity of 61% in the diagnosis of acute appendicitis. Total serum bilirubin more than 0.85 mg/dl was the cut-off value with the best performance for diagnosis of appendicitis.
Bilirubin levels are reliable, sensitive and specific to diagnosis and a prediction of complicated appendicitis.
急性阑尾炎的临床诊断仍然是一个问题。急性阑尾炎诊断的延迟可能导致穿孔和化脓性腹膜炎，从而增加发病率和死亡率。本研究的目的是确定血清总胆红素水平作为急性阑尾炎预测指标的敏感性、特异性和诊断价值。
在这项横断面研究中，纳入了2012年4月至2013年3月在伊朗马什哈德伊玛目礼萨医院接受急性阑尾炎诊断并进行阑尾切除术的患者。测量血清总胆红素和直接胆红素。然后根据最终病理报告，将患者分为正常阑尾、慢性炎症改变、急性阑尾炎、坏疽和/或坏死改变以及穿孔性阑尾炎五组。使用SPSS 16版进行独立样本t检验、方差分析和卡方检验进行数据分析。
共研究了174例患者（男性117例，女性57例），平均年龄27.15±0.7岁。所有患者均有反跳痛；75.3%有恶心，58.6%有厌食，21.3%有发热。所有患者的组织学报告显示76.4%为急性阑尾炎。分析谷丙转氨酶、谷草转氨酶、白细胞的p值为（p = 0.903），分类计数为（p = 0.959）。研究表明病理组之间无显著差异。然而，病理组之间血清总胆红素水平无显著差异。总胆红素在急性阑尾炎诊断中的敏感性为48%，特异性为61%。血清总胆红素超过0.85mg/dl是诊断阑尾炎性能最佳的临界值。
胆红素水平对于复杂阑尾炎的诊断和预测是可靠、敏感和特异的。
