Çınar Hamza, Aygün Ali, Derebey Murat, Tarım İsmail Alper, Akalın Çağrı, Büyükakıncak Sercan, Erzurumlu Kenan
Department of General Surgery, Ordu University Faculty of Medicine, Ordu-Turkey.
Ulus Travma Acil Cerrahi Derg. 2018 Sep;24(5):423-428. doi: 10.5505/tjtes.2018.62753.
Acute appendicitis (AA) is the most common emergency surgical condition during pregnancy after obstetric and gynecological pathologies. Urgent and accurate diagnosis of AA in pregnant patients reduces maternal and fetal morbidity/mortality rates. This study evaluated the significance of hemogram to diagnose AA during pregnancy.
Forty-seven pregnant patients operated for AA in the Ordu or Ondokuz Mayis University Medical School Hospitals between January 2007 and December 2017 were compared with 47 healthy pregnant women in terms of hemogram parameters, including the white blood cell (WBC) count, neutrophil count, lymphocyte count, platelet count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and red cell distribution width (RDW) values. The operated group was evaluated based on post-operative pathologic results and subclassified into appendicitis positive (Group A) and appendicitis negative (Group B) groups. The subgroups were compared to the control group.
The WBC and neutrophil count and mean NLR and PLR values were significantly higher in Group A compared to Group B and the control group (p<0.001). The mean lymphocyte count was significantly lower in Group A compared to other groups (p<0.001). The MPV and RDW values and mean platelet count showed no significant difference between groups (p>0.05). When cutoff values for WBC, neutrophil count, NLR, PLR, and lymphocyte counts were set to >10300, >7950, >5.50, >155.2, and ≤1330, respectively, the sensitivity rates were 72.5%, 80%, 90%, 77.5% and 85%, whereas specificity rates were 72.3%, 79.7%, 89.4%, 74.5%, and 82.5%, respectively.
When comparing pregnant women diagnosed with AA to patients operated for suspected AA and healthy pregnant women, the WBC and neutrophil count and NLR and PLR values were found to be significantly higher, whereas lymphocyte counts were lower. In addition to medical history, physical examination and imaging techniques, hemogram parameters should be considered to diagnose AA in pregnant women.
急性阑尾炎（AA）是继妇产科疾病之后孕期最常见的急诊手术疾病。对孕妇进行快速准确的急性阑尾炎诊断可降低母婴发病率/死亡率。本研究评估了血常规对孕期急性阑尾炎诊断的意义。
将2007年1月至2017年12月期间在奥尔杜或于讷尔杰伊大学医学院医院因急性阑尾炎接受手术的47例孕妇与47例健康孕妇在血常规参数方面进行比较，这些参数包括白细胞（WBC）计数、中性粒细胞计数、淋巴细胞计数、血小板计数、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、平均血小板体积（MPV）和红细胞分布宽度（RDW）值。手术组根据术后病理结果进行评估，并分为阑尾炎阳性（A组）和阑尾炎阴性（B组）两组。将各亚组与对照组进行比较。
A组的白细胞和中性粒细胞计数以及平均NLR和PLR值显著高于B组和对照组（p<0.001）。A组的平均淋巴细胞计数显著低于其他组（p<0.001）。MPV和RDW值以及平均血小板计数在各组之间无显著差异（p>0.05）。当白细胞、中性粒细胞计数、NLR、PLR和淋巴细胞计数的临界值分别设定为>10300、>7950、>5.50、>155.2和≤1330时，敏感性分别为72.5%、80%、90%、77.5%和85%，而特异性分别为72.3%、79.7%、89.4%、74.5%和82.5%。
将诊断为急性阑尾炎的孕妇与因疑似急性阑尾炎接受手术的患者及健康孕妇进行比较时，发现白细胞和中性粒细胞计数以及NLR和PLR值显著更高，而淋巴细胞计数更低。除病史、体格检查和影像学技术外，血常规参数也应作为诊断孕妇急性阑尾炎的考虑因素。
