Boshnak Noha, Boshnaq Mohamed, Elgohary Hatem
a Department of Clinical Pathology, Faculty of Medicine , Ain Shams University , Cairo , Egypt.
b Department of General Surgery , Queen Elizabeth the Queen Mother Hospital , Margate , Kent , UK.
J Invest Surg. 2018 Apr;31(2):121-129. doi: 10.1080/08941939.2017.1284964. Epub 2017 Feb 16.
Debate around the value of laboratory tests in establishing the diagnosis of acute appendicitis (AA) still continues. This prospective study aimed to investigate the changes in mean platelet volume (MPV), platelet distribution width (PDW), and red cell distribution width (RDW) with the diagnosis of acute appendicitis.
200 patients who underwent emergency appendectomy were included. According to postoperative histology, patients were divided into three groups: acute non-complicated, acute complicated appendicitis (positive appendicectomy groups), and negative appendectomy group. White blood cell (WBC), neutrophil, lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), platelets (PLT) count, MPV, PDW, RDW, and C-reactive protein (CRP) were compared among the groups.
One hundred twenty-five (62.5%) patients had non-complicated acute appendicitis, 20 (10%) had complicated acute appendicitis, while 55 (27.5%) had normal appendix. WBC (p <.001), neutrophil (p <.001), NLR (p <.001), PDW (p =.003), and CRP (p =.001) were higher, while lymphocyte (p <.001) and PLT counts (p =.020) were lower in positive appendectomy compared with negative appendectomy patients. MPV levels were insignificantly different across the groups. RDW level was significantly higher in complicated compared with non-complicated acute appendicitis (p =.006); however, no significant difference was found between positive and negative appendectomy groups. Using receiver operating characteristic analysis, sensitivity, specificity, and diagnostic accuracy respectively were 44.83, 100.0, and 72.415% for WBC count, 72.41, 81.82, and 77.115% for neutrophil count, 48.28, 90.91, and 69.595% for PDW, 89.66, 63.64, and 76.65% for CRP.
Increased PDW combined with elevated WBC and neutrophil counts maybe used as diagnostic tests in the cases of acute appendicitis, while MPV and RDW levels were not useful diagnostic markers.
关于实验室检查在急性阑尾炎（AA）诊断中的价值的争论仍在继续。这项前瞻性研究旨在调查急性阑尾炎诊断时平均血小板体积（MPV）、血小板分布宽度（PDW）和红细胞分布宽度（RDW）的变化。
纳入200例行急诊阑尾切除术的患者。根据术后组织学检查，将患者分为三组：急性非复杂性阑尾炎、急性复杂性阑尾炎（阑尾切除阳性组）和阑尾切除阴性组。比较三组患者的白细胞（WBC）、中性粒细胞、淋巴细胞计数、中性粒细胞与淋巴细胞比值（NLR）、血小板（PLT）计数、MPV、PDW、RDW和C反应蛋白（CRP）。
125例（62.5%）患者为非复杂性急性阑尾炎，20例（10%）为复杂性急性阑尾炎，55例（27.5%）阑尾正常。与阑尾切除阴性患者相比，阑尾切除阳性患者的WBC（p<.001）、中性粒细胞（p<.001）、NLR（p<.001）、PDW（p =.003）和CRP（p =.001）较高，而淋巴细胞（p<.001）和PLT计数（p =.020）较低。各组间MPV水平差异无统计学意义。与非复杂性急性阑尾炎相比，复杂性急性阑尾炎的RDW水平显著更高（p =.006）；然而，阑尾切除阳性组和阴性组之间未发现显著差异。采用受试者工作特征分析，WBC计数的敏感性、特异性和诊断准确性分别为44.83%、100.0%和72.415%，中性粒细胞计数分别为72.41%、81.82%和77.115%，PDW分别为48.28%、90.91%和69.595%，CRP分别为89.66%、63.64%和76.65%。
PDW升高联合WBC和中性粒细胞计数升高可作为急性阑尾炎病例的诊断检查，而MPV和RDW水平不是有用的诊断标志物。
