Beliaev Andrei M, Booth Michael, Rowbotham David, Bergin Colleen
Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland, New Zealand.
Department of General Surgery, North Shore Hospital, Auckland, New Zealand.
J Surg Res. 2018 Aug;228:35-41. doi: 10.1016/j.jss.2018.02.048. Epub 2018 Mar 26.
The 2018 Tokyo guidelines for acute cholangitis (AC) use white cell count (WCC) as one of the diagnostic criteria. However, the 2018 Tokyo guidelines grading does not provide guidance for AC patients with normal WCC. In this situation, other inflammatory biomarkers also can be used to diagnose AC and grade severity, but their diagnostic values are yet undetermined. The aims of this study were to evaluate the discriminative powers of common inflammatory markers compared with WCC for diagnosing AC and to determine their diagnostic cutoff levels.
This was a retrospective cohort study. Over 2 y, 96 patients who underwent endoscopic biliary decompression were identified from the Auckland City Hospital Radiology Department database. Only patients with a confirmed diagnosis of AC were included in the study. Thirty-four patients with AC and 18 controls met eligibility criteria.
Comparing areas under the receiver operating characteristic curves, it was the lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP) that had the highest discriminative powers in diagnosing AC. Values of WCC for diagnosing AC were equal to or above 9.6 × 10/L, neutrophil count equal to or exceeding 4.9 × 10/L, lymphocyte count equal to or below 1.3 × 10/L, NLR 5.3 and above, albumin equal to or below 30.5 g/L, and CRP concentration 23.5 mg/L or above.
Lymphocyte count, NLR, and CRP have superior discriminative powers to WCC, albumin, and neutrophil count and can be useful in the diagnosis of AC.
2018年东京急性胆管炎（AC）指南将白细胞计数（WCC）作为诊断标准之一。然而，2018年东京指南分级并未为WCC正常的AC患者提供指导。在这种情况下，其他炎症生物标志物也可用于诊断AC并评估严重程度，但它们的诊断价值尚未确定。本研究的目的是评估常见炎症标志物与WCC相比对AC的诊断鉴别能力，并确定其诊断临界值。
这是一项回顾性队列研究。在两年多的时间里，从奥克兰市医院放射科数据库中确定了96例接受内镜下胆道减压的患者。只有确诊为AC的患者被纳入研究。34例AC患者和18例对照符合入选标准。
比较受试者工作特征曲线下面积，淋巴细胞计数、中性粒细胞与淋巴细胞比值（NLR）和C反应蛋白（CRP）在诊断AC时具有最高的鉴别能力。诊断AC时WCC值等于或高于9.6×10⁹/L，中性粒细胞计数等于或超过4.9×10⁹/L，淋巴细胞计数等于或低于1.3×10⁹/L，NLR为5.3及以上，白蛋白等于或低于30.5 g/L，CRP浓度为23.5 mg/L或以上。
淋巴细胞计数、NLR和CRP对AC的诊断鉴别能力优于WCC、白蛋白和中性粒细胞计数，可用于AC的诊断。
