白细胞介素-6血清水平可增强急性阑尾炎标准血液检测的诊断能力。
IL-6 Serum Levels Can Enhance the Diagnostic Power of Standard Blood Tests for Acute Appendicitis.
作者信息
Di Mitri Marco, Parente Giovanni, Bonfiglioli Giulia, Thomas Eduje, Bisanti Cristian, Cordola Chiara, Vastano Marzia, Cravano Sara, Collautti Edoardo, Di Carmine Annalisa, D'Antonio Simone, Gargano Tommaso, Libri Michele, Lima Mario
机构信息
Paediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, 40138 Bologna, Italy.
出版信息
Children (Basel). 2022 Sep 20;9(10):1425. doi: 10.3390/children9101425.
BACKGROUND
The diagnosis of acute appendicitis (AA) remains challenging, especially in pediatrics, because early symptoms are not specific, and the younger the patient the more difficult their interpretation is. There is a large degree of agreement between pediatric surgeons on the importance of an early diagnosis to avoid complicated acute appendicitis (CAA) and its consequences. The aim of this study is to assess if Interleukin 6 (IL-6) could enhance the sensitivity (Sn) and specificity (Sp) of the currently available and routinely performed diagnostic tools in case of suspected AA in pediatric patients.
MATERIALS AND METHODS
A prospective observational study was conducted including patients who underwent appendectomy between November 2020 and March 2022. We divided patients into three groups: not inflamed appendix (group NA), not complicated AA (group NCAA), and complicated AA (group CAA). We compared the mean values of white blood cells (WBC), neutrophils, fibrinogen, ferritin, aPTT, INR, C-reactive protein (CRP), IL-6, and CRP between the three groups. Then we evaluated Sn, Sp, and odds ratio (OR) of IL-6 and CRP alone and combined.
RESULTS
We enrolled 107 patients operated on for AA (22 in Group NA, 63 in Group NCAA, and 21 in group CAA). CRP levels resulted in a significant increase when comparing CAA with NA ( = 0.01) and CAA with NCAA ( = 0.01), whereas no significance was found between NA and NCAA ( = 0.38). A statistically significant increase in average IL-6 levels was found when comparing NCAA with NA ( = 0.04), CAA with NA ( = 0.04), and CAA with NCAA ( = 0.02). Considering CRP alone, its Sn, Sp, and OR in distinguishing NA from AA (both NCAA and CAA together) are 86%, 35%, and 33,17, respectively. Similarly, Sn, Sp, and OR of IL-6 alone are 82%, 54%, and 56, respectively. Combining CRP and IL-6 serum levels together, the Sn increases drastically to 100% with an Sp of 40% and OR of 77.
CONCLUSIONS
Our study may suggest an important role of IL-6 in the detection of AA in its early stage, especially when coupled with CRP.
背景
急性阑尾炎（AA）的诊断仍然具有挑战性，尤其是在儿科，因为早期症状不具特异性，且患者年龄越小，对症状的解读就越困难。小儿外科医生在早期诊断以避免复杂性急性阑尾炎（CAA）及其后果的重要性上存在很大程度的共识。本研究的目的是评估白细胞介素6（IL-6）是否能提高目前可用且常规执行的诊断工具在疑似小儿AA患者中的敏感性（Sn）和特异性（Sp）。
材料与方法
进行了一项前瞻性观察性研究，纳入2020年11月至2022年3月期间接受阑尾切除术的患者。我们将患者分为三组：阑尾未发炎组（NA组）、非复杂性AA组（NCAA组）和复杂性AA组（CAA组）。我们比较了三组之间白细胞（WBC）、中性粒细胞、纤维蛋白原、铁蛋白、活化部分凝血活酶时间（aPTT）、国际标准化比值（INR）、C反应蛋白（CRP）、IL-6和CRP的平均值。然后我们评估了单独及联合使用IL-6和CRP的Sn、Sp和比值比（OR）。
结果
我们纳入了107例接受AA手术的患者（NA组22例，NCAA组63例，CAA组21例）。将CAA组与NA组比较（P = 0.01）以及CAA组与NCAA组比较时（P = 0.01），CRP水平显著升高，而NA组与NCAA组之间无显著差异（P = 0.38）。将NCAA组与NA组比较（P = 0.04）、CAA组与NA组比较（P = 0.04）以及CAA组与NCAA组比较时（P = 0.02），发现平均IL-6水平有统计学意义的升高。单独考虑CRP时，其在区分NA组与AA组（NCAA组和CAA组合并）时的Sn、Sp和OR分别为86%、35%和33.17。同样，单独IL-6的Sn、Sp和OR分别为82%、54%和56。将CRP和IL-6血清水平联合起来，Sn大幅提高到100%，Sp为40%，OR为77。
结论
我们的研究可能表明IL-6在AA早期检测中具有重要作用，尤其是与CRP联合使用时。
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