低钠血症可预测小儿穿孔性急性阑尾炎：一项前瞻性研究。

Hyponatremia as a predictor of perforated acute appendicitis in pediatric population: A prospective study.

机构信息

Department of Pediatric Surgery, University Hospital of Split, Spinčićeva 1, 21 000 Split, Croatia; Department of Surgery, University of Split, School of Medicine, Šoltanska 2, 21 000 Split, Croatia.

Department of Surgery, University of Split, School of Medicine, Šoltanska 2, 21 000 Split, Croatia.

出版信息

J Pediatr Surg. 2021 Oct;56(10):1816-1821. doi: 10.1016/j.jpedsurg.2020.09.066. Epub 2020 Oct 8.

DOI:10.1016/j.jpedsurg.2020.09.066

PMID:33153722

Abstract

BACKGROUND

The aim of this study was to investigate hyponatremia as a new biochemical marker associated with complicated appendicitis in the pediatric population.

METHODS

Pediatric patients (n = 184) with acute appendicitis confirmed by histopathology were enrolled in a prospective cohort study from January 2019 to May 2020. Medical history, demographic and clinical data were recorded in the study protocol. Blood samples for biochemical analysis, electrolytes and acute inflammatory markers were taken before surgery. Patients were further divided in two groups, those with non-perforated (n = 148; 79%) and perforated appendicitis (n = 38; 21%).

RESULTS

The mean serum sodium level in patients with complicated appendicitis was significantly lower compared to patients with non-complicated appendicitis (132.2 mmol/L vs. 139.2 mmol/L, p < 0.001). The receiver operating characteristic curve of plasma sodium concentration in patients who were diagnosed with perforated acute appendicitis showed an area under the curve of 0.983 (95% CI, 0.963-1.00). A cut-off-value of plasma sodium concentration of ≤135 mmol/L was shown to give the best possible sensitivity and specificity, 94.7% (95% CI: 82.2-99.3) and 88.5% (95% CI: 88.2-93.2) respectively (p < 0.001). Patients with complicated appendicitis were more likely to be younger than five years of age (10.5% vs. 1.4%, p = 0.005), have a duration of symptoms for >24 h (97.4% vs. 59.6%, p < 0.001), sodium serum concentration ≤135 mmol/L (89.5% vs. 5.5%, p < 0.001), body temperature >38.5 °C (47.4% vs. 11.0%, p < 0.001) and CRP serum concentration >62 mg/L (26% vs. 2%, p < 0.001).

CONCLUSION

Hyponatremia is a novel and very discriminative marker of complicated appendicitis in the pediatric population, and is therefore recommended in appendicitis diagnostic and treatment planning.

TYPE OF STUDY

Prospective comparative study LEVEL OF EVIDENCE: II.

摘要

背景

本研究旨在探讨低钠血症是否为儿科复杂阑尾炎的新生化标志物。

方法

本前瞻性队列研究纳入了 2019 年 1 月至 2020 年 5 月期间经组织病理学证实为急性阑尾炎的儿科患者 184 例。研究方案中记录了患者的病史、人口统计学和临床数据。手术前采集血液样本进行生化分析、电解质和急性炎症标志物检测。根据是否合并穿孔，患者进一步分为非穿孔性阑尾炎组（n = 148；79%）和穿孔性阑尾炎组（n = 38；21%）。

结果

与非复杂性阑尾炎患者相比，合并复杂性阑尾炎的患者血清钠水平明显更低（132.2 mmol/L vs. 139.2 mmol/L，p < 0.001）。诊断为穿孔性急性阑尾炎的患者的血浆钠浓度受试者工作特征曲线下面积为 0.983（95%可信区间，0.963-1.00）。血浆钠浓度≤135 mmol/L 的截断值显示出最佳的灵敏度和特异性，分别为 94.7%（95%可信区间：82.2-99.3）和 88.5%（95%可信区间：88.2-93.2）（p < 0.001）。合并复杂性阑尾炎的患者更有可能年龄小于 5 岁（10.5% vs. 1.4%，p = 0.005）、症状持续时间>24 h（97.4% vs. 59.6%，p < 0.001）、血清钠浓度≤135 mmol/L（89.5% vs. 5.5%，p < 0.001）、体温>38.5°C（47.4% vs. 11.0%，p < 0.001）和 CRP 血清浓度>62 mg/L（26% vs. 2%，p < 0.001）。