Delgado-Miguel Carlos, García Antonella, Delgado Bonifacio, Muñoz-Serrano Antonio Jesus, Miguel-Ferrero Miriam, Camps Juan, Lopez-Santamaria Manuel, Martinez Leopoldo
Department of Pediatric Surgery, Prisma Health Children's Hospital, Columbia, South Carolina, United States.
Department of Surgery, Faculty of Medicine, Autonomous University of Madrid, Madrid, Madrid, Spain.
Eur J Pediatr Surg. 2023 Oct;33(5):422-427. doi: 10.1055/a-1913-4280. Epub 2022 Jul 29.
Neutrophil-to-lymphocyte ratio (NLR) is an emerging inflammatory marker in abdominal pathologies. Ileocolic intussusception (ICI) involves a progressive intestinal inflammation, and the effectiveness of nonsurgical treatment (enema) might be related to the inflammation degree, although no previous studies have investigated this relationship. Our aim is to identify predictors of the need for surgical treatment in ICI.
A single-center, retrospective, case-control study was performed in children with ICI, who were treated with initial nonsurgical management between 2005 and 2019. Patients were divided in two groups: A (effective enema) and B (need for surgery). Admission demographic and clinical and laboratory data were analyzed. Specificity and sensitivity of the different parameters as predictors of the need for surgical treatment were determined by receiver operating characteristic (ROC) curves.
A total of 511 patients were included (410: group A; 101: group B), without statistically significant demographic differences. Group B presented significantly higher frequency of vomiting, bloody stools, and longer median time since symptoms onset (24 vs. 8 hours; < 0.001). Group B presented higher median laboratory inflammatory markers than group A: NLR (6.8 vs. 1.8; < 0.001), neutrophils (10,148 vs. 7,468; < 0.001), and C-reactive protein (CRP; 28.2 vs. 4.7; < 0.001). In ROC curve analysis, NLR had an area under the curve of 0.925, higher than neutrophil count (0.776; = 0.001), CRP (0.670; = 0.001), and time since symptoms onset (0.673; = 0.001). It was estimated a cut-off point of NLR greater than 4.52 (sensitivity: 73.2%; specificity: 94.5%).
High NLR values imply a high degree of bowel inflammation and might anticipate the need for surgical treatment in ICI in children.
III.
中性粒细胞与淋巴细胞比值（NLR）是腹部疾病中一种新出现的炎症标志物。回结肠套叠（ICI）会导致进行性肠道炎症，非手术治疗（灌肠）的有效性可能与炎症程度有关，尽管此前尚无研究探讨这种关系。我们的目的是确定ICI患儿手术治疗需求的预测因素。
对2005年至2019年间接受初始非手术治疗的ICI患儿进行了一项单中心、回顾性病例对照研究。将患者分为两组：A组（灌肠有效）和B组（需要手术）。分析了入院时的人口统计学、临床和实验室数据。通过受试者工作特征（ROC）曲线确定不同参数作为手术治疗需求预测指标的特异性和敏感性。
共纳入511例患者（410例：A组；101例：B组），人口统计学差异无统计学意义。B组呕吐、血便的发生率显著更高，症状出现后的中位时间更长（24小时对8小时；<0.001）。B组实验室炎症标志物的中位值高于A组：NLR（6.8对1.8；<0.001）、中性粒细胞（10148对7468；<0.001）和C反应蛋白（CRP；28.2对4.7；<0.001）。在ROC曲线分析中，NLR的曲线下面积为0.925，高于中性粒细胞计数（0.776；=0.001）、CRP（0.670；=0.001）和症状出现后的时间（0.673；=0.001）。估计NLR的截断点大于4.52（敏感性：73.2%；特异性：94.5%）。
高NLR值意味着肠道炎症程度较高，可能预示着儿童ICI患者需要手术治疗。
III级。
