Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Università Degli Studi of Milan, Italy.
Afr J Paediatr Surg. 2020 Jul-Dec;17(3 & 4):59-63. doi: 10.4103/ajps.AJPS_52_20.
Appendicitis is the commonest and most frequently misdiagnosed acute abdominal surgical illness in the paediatric population worldwide. The aim of this study is to evaluate the role of coagulation profile in acute appendicitis (AA) in children.
we retrospectively collected data of patients submitted to appendectomy from 2011 to 2017. According to histopathology, patients were divided into three groups: not histologically confirmed AA (NAA), simple AA (SAA) and complicated AA (CAA). White blood cell (WBC) count, relative neutrophilia (Neutr%), C-reactive protein (CRP), prothrombin time ratio (PTratio), activated partial thromboplastin time ratio (APTTratio) and fibrinogen (Fib) were compared among groups.
Three hundred and seven patients were included: 57 NAA, 184 SAA and 66 CAA. WBC was significantly different among groups: CAA (mean 16.67 × 10/ml), SAA (14.73 × 10/ml, P= 0.01) and NAA (10.85 × 10/ml, P< 0.0001). Significant differences were found for Neutr% (mean CAA 81.14 vs. SAA 77.03 P= 0.006, vs. NAA 63.86 P< 0.0001) and CRP (mean NAA 2.56, SAA 3.26, CAA 11.58, P< 0.0001). PTratio and Fib increased with the severity of AA receiver operator characteristic curves were similar for CRP (0.739), Fib (0.726), WBC (0.746) and Neutr% (0.754), while for PTratio and aPTTratio were 0.634 and 0.441, respectively.
extrinsic coagulation pathway is altered in AA, especially in CAA. Coagulation can be useful in the diagnostic and perioperative anaesthetic management of AA in children. Fib seems to have the highest accuracy.
阑尾炎是全世界儿科人群中最常见和最常误诊的急性腹部外科疾病。本研究旨在评估凝血谱在儿童急性阑尾炎（AA）中的作用。
我们回顾性收集了 2011 年至 2017 年接受阑尾切除术的患者数据。根据组织病理学，患者分为三组：未组织学证实的 AA（NAA）、单纯性 AA（SAA）和复杂性 AA（CAA）。比较各组间白细胞（WBC）计数、相对中性粒细胞增多（Neutr%）、C 反应蛋白（CRP）、凝血酶原时间比值（PTratio）、活化部分凝血活酶时间比值（APTTratio）和纤维蛋白原（Fib）。
共纳入 307 例患者：57 例 NAA、184 例 SAA 和 66 例 CAA。WBC 在各组间差异有统计学意义：CAA（平均 16.67×10/ml）、SAA（14.73×10/ml，P=0.01）和 NAA（10.85×10/ml，P<0.0001）。Neutr%也有显著差异（CAA 组 81.14%，SAA 组 77.03%，P=0.006，NAA 组 63.86%，P<0.0001）和 CRP（NAA 组 2.56mg/dL、SAA 组 3.26mg/dL、CAA 组 11.58mg/dL，P<0.0001）。PTratio 和 Fib 随 AA 严重程度增加，CRP（0.739）、Fib（0.726）、WBC（0.746）和 Neutr%（0.754）的受试者工作特征曲线相似，而 PTratio 和 aPTTratio 分别为 0.634 和 0.441。
外源性凝血途径在 AA 中发生改变，尤其是在 CAA 中。凝血在儿童 AA 的诊断和围手术期麻醉管理中可能有用。Fib 的准确性似乎最高。
