Kakar Mohit, Delorme Mathilde, Broks Renars, Asare Lasma, Butnere Marisa, Reinis Aigars, Engelis Arnis, Kroica Juta, Saxena Amulya, Petersons Aigars
Department of Pediatric Surgery, Children's Clinical University Hospital, Vienibas gatve, 45, Riga, 1004, Latvia.
Department of Pediatric Surgery, Riga Stradins University, Dzirciema iela, 16, Riga, Latvia.
Pediatr Surg Int. 2020 May;36(5):629-636. doi: 10.1007/s00383-020-04650-y. Epub 2020 Mar 26.
The study aim is to determine whether serum and urine interleukin-6 (IL-6) and neutrophil gelatinase-associated lipocalin (NGAL) can be included in the early diagnostic algorithm for pediatric appendicitis.
Prospective single-center cohort study included 92 children divided into control, acute complicated appendicitis (AcA) and acute uncomplicated appendicitis (AnA) groups. Serum and urine samples were assayed for IL-6 and NGAL preoperatively, and on the second and fifth postoperative days. Intraoperative and bacteriological findings divided the appendicitis patients.
Average serum biomarker levels were higher in appendicitis patients versus the control, and the following values were produced via receiver operating characteristic (ROC) analysis. NGAL and IL-6 cutoff values were 113.95 ng/ml and 24.64 pg/ml, respectively, NGAL had 68.3% sensitivity and 65.5% specificity, while IL-6 had 72.6% and 86.2%. Comparing AcA and AnA, IL-6 was the only biomarker of significance yielding 77.4% sensitivity and 58.1% specificity with a 26.43 pg/ml cutoff value. Urine biomarkers were non-specific in differentiation appendicitis severity and ultimately, between infectious and non-infectious disease.
Although NGAL provided measurable useful diagnostic information in evaluating children for appendicitis, its values were not sufficient for appendicitis severity. Serum IL-6 remains a strong biomarker for suspected acute appendicitis and has promising results predicting its severity.
本研究旨在确定血清和尿液白细胞介素-6（IL-6）以及中性粒细胞明胶酶相关脂质运载蛋白（NGAL）是否可纳入小儿阑尾炎的早期诊断算法。
前瞻性单中心队列研究纳入了92名儿童，分为对照组、急性复杂性阑尾炎（AcA）组和急性非复杂性阑尾炎（AnA）组。术前以及术后第二天和第五天对血清和尿液样本进行IL-6和NGAL检测。术中及细菌学检查结果将阑尾炎患者进行了分类。
阑尾炎患者的平均血清生物标志物水平高于对照组，通过受试者工作特征（ROC）分析得出以下数值。NGAL和IL-6的截断值分别为113.95 ng/ml和24.64 pg/ml，NGAL的灵敏度为68.3%，特异性为65.5%，而IL-6的灵敏度和特异性分别为72.6%和86.2%。比较AcA和AnA时，IL-6是唯一具有显著意义的生物标志物，截断值为26.43 pg/ml时，灵敏度为77.4%，特异性为58.1%。尿液生物标志物在区分阑尾炎严重程度以及最终区分感染性和非感染性疾病方面并无特异性。
尽管NGAL在评估儿童阑尾炎时提供了可测量的有用诊断信息，但其数值不足以判断阑尾炎的严重程度。血清IL-6仍然是疑似急性阑尾炎的有力生物标志物，在预测其严重程度方面有良好结果。
