Chen Lixia, Zhang Yuezhan
Clin Lab. 2020 Jan 1;66(1). doi: 10.7754/Clin.Lab.2019.190632.
To compare the diagnostic values of leukocytes, neutrophils, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in distinguishing between acute appendicitis (AA) and right ureterolithiasis (RU).
In this retrospective study, 106 patients diagnosed with AA (Appendicitis group) and 33 cases with RU (Ureterolithiasis group) were enrolled due to acute right lower abdominal pain. The levels of peripheral blood leukocyte counts (leukocytes), neutrophil counts (neutrophils), lymphocyte counts (lymphocytes), platelet counts (platelets), NLR and PLR were recorded and compared between the two groups. Student's t-test for independent samples was adopted for comparing the mean between the two groups. Model discrimination was evaluated using the area under the receiver operating characteristic curve (AUC). Comparison of AUC was performed using the Z-test.
The levels of leukocytes, neutrophils, NLR, and PLR were significantly increased in AA compared with RU (all p < 0.01), while there were no significant statistical differences of lymphocytes and platelets (all p > 0.05); moreover, AUC in distinguishing AA from RU was 0.797 (95% confidence interval (CI), 0.721 to 0.861) for leukocytes, 0.814 (95% CI, 0.740 to 0.875) for neutrophils, 0.770 (95% CI, 0.691 to 0.837) for NLR, and 0.608 (95% CI, 0.522 to 0.690) for PLR, and significant differences were observed between PLR and any of the three other parameters (all p < 0.01), while there were no significant statistical differences after pairwise comparison between leukocytes, neutrophils and NLR (all p > 0.05). Finally, the cutoff values were 13.1 × 109/L in distinguishing between AA and RU (specificity 87.88%, sensitivity 63.21%, and Youden index 0.511) for leukocytes, 7.4 x 109/L (specificity 69.70%, sensitivity 83.02%, and Youden index 0.527) for neutrophils, 5.57 (specificity 81.82%, sensitivity 68.87%, and Youden index 0.507) for NLR, and 182.5 (specificity 84.85%, sensitivity 37.74%, and Youden index 0.226) for PLR.
Leukocytes, neutrophils, and NLR can demonstrate more accurate and reliable diagnostic values than PLR, suggesting that they are useful and potential biomarkers in distinguishing between AA and RU.
比较白细胞、中性粒细胞、中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）在鉴别急性阑尾炎（AA）和右侧输尿管结石（RU）中的诊断价值。
在这项回顾性研究中，106例因急性右下腹痛被诊断为AA的患者（阑尾炎组）和33例RU患者（输尿管结石组）纳入研究。记录并比较两组外周血白细胞计数（白细胞）、中性粒细胞计数（中性粒细胞）、淋巴细胞计数（淋巴细胞）、血小板计数（血小板）、NLR和PLR水平。采用独立样本t检验比较两组均值。使用受试者操作特征曲线（AUC）下面积评估模型判别能力。采用Z检验比较AUC。
与RU相比，AA患者的白细胞、中性粒细胞、NLR和PLR水平显著升高（均p<0.01），而淋巴细胞和血小板无显著统计学差异（均p>0.05）；此外，白细胞鉴别AA与RU的AUC为0.797（95%置信区间（CI），0.721至0.861），中性粒细胞为0.814（95%CI，0.740至0.875），NLR为0.770（95%CI，0.691至0.837），PLR为0.608（95%CI，0.522至0.690），PLR与其他三个参数中的任何一个均存在显著差异（均p<0.01），而白细胞、中性粒细胞和NLR两两比较后无显著统计学差异（均p>0.05）。最后，白细胞鉴别AA与RU的截断值为13.1×10⁹/L（特异性87.88%，敏感性63.21%，约登指数0.511），中性粒细胞为7.4×10⁹/L（特异性69.70%，敏感性83.02%，约登指数0.527），NLR为5.57（特异性81.82%，敏感性68.87%，约登指数0.507），PLR为182.5（特异性84.85%，敏感性37.74%，约登指数0.226）。
白细胞、中性粒细胞和NLR比PLR能显示出更准确可靠的诊断价值，表明它们在鉴别AA和RU方面是有用的潜在生物标志物。
