血清五聚素-3 在儿科急性阑尾炎中的诊断性能：一项前瞻性诊断验证研究。
Diagnostic performance of serum pentraxin-3 in pediatric acute appendicitis: a prospective diagnostic validation study.
机构信息
Pediatric Surgery Department, Hospital Universitario de Navarra, Calle Irunlarrea 3, 31008, Pamplona, Navarra, Spain.
School of Medicine, University of Navarra, Pamplona, Navarra, Spain.
出版信息
Pediatr Surg Int. 2022 Dec 1;39(1):27. doi: 10.1007/s00383-022-05289-7.
INTRODUCTION
Pediatric acute appendicitis (PAA) is a pathology with a high rate of diagnostic error. The search for new diagnostic tools is justified by the high morbidity and healthcare costs associated with diagnostic error.
METHODS
We designed a prospective study to validate serum pentraxin-3 (PTX3) as a diagnostic tool in PAA. Participants were divided into three groups: (1) patients with no underlying pathology (2) patients with non-surgical abdominal pain and (3) patients with a confirmed diagnosis of PAA. For further analyses, patients in group 3 were divided into complicated or uncomplicated PAA. Quantitative variables were expressed as medians and interquartile ranges and categorical variables as percentages. Quantitative variables were compared using the Kruskal-Wallis test and the Mann-Whitney U test. Diagnostic performance was evaluated with ROC curves.
RESULTS
This study included 215 patients divided into group 1 (n = 63), group 2 (n = 53) and group 3 (n = 99). Median serum PTX3 values were 2.54 (1.70-2.95) ng/mL, 3.29 (2.19-7.64) ng/mL and 8.94 (6.16-14.05) in groups 1, 2 and 3, respectively (p = 0.001). Patients with complicated PAA showed significantly higher values than patients with uncomplicated PAA (p = 0.04). The AUC (group 2 vs. 3) was 0.77 (95% CI 0.69-0.85) and the best cut-off point was at 7.28 ng/mL, with a sensitivity of 61.3% and a specificity of 73.1%. The AUC (complicated vs. uncomplicated PAA) was 0.65 (95% CI 0.54-0.77) and the best cut-off point was 12.33 ng/mL, with a sensitivity of 51.72% and a specificity of 72.73%.
CONCLUSIONS
The diagnostic ability of serum PTX3 in PAA is only moderate and therefore it cannot be considered a definitive diagnostic test. The discriminatory ability of PTX3 between complicated and uncomplicated PAA is poor. These findings, which contrast with those reported to date, should be validated with future properly designed prospective studies.
简介
小儿急性阑尾炎（PAA）是一种诊断错误率较高的疾病。由于诊断错误与高发病率和医疗保健成本相关，因此有理由寻找新的诊断工具。
方法
我们设计了一项前瞻性研究，以验证血清 pentraxin-3（PTX3）作为 PAA 的诊断工具。参与者分为三组：（1）无潜在病理的患者；（2）非手术性腹痛的患者；（3）确诊为 PAA 的患者。为了进一步分析，将第 3 组患者分为复杂或非复杂 PAA。定量变量表示为中位数和四分位距，分类变量表示为百分比。使用 Kruskal-Wallis 检验和 Mann-Whitney U 检验比较定量变量。使用 ROC 曲线评估诊断性能。
结果
本研究共纳入 215 例患者，分为第 1 组（n=63）、第 2 组（n=53）和第 3 组（n=99）。第 1、2 和 3 组患者的血清 PTX3 值中位数分别为 2.54（1.70-2.95）ng/mL、3.29（2.19-7.64）ng/mL 和 8.94（6.16-14.05）ng/mL（p=0.001）。复杂性 PAA 患者的血清 PTX3 值显著高于非复杂性 PAA 患者（p=0.04）。AUC（第 2 组 vs. 第 3 组）为 0.77（95%CI 0.69-0.85），最佳截断值为 7.28 ng/mL，灵敏度为 61.3%，特异性为 73.1%。AUC（复杂性 vs. 非复杂性 PAA）为 0.65（95%CI 0.54-0.77），最佳截断值为 12.33 ng/mL，灵敏度为 51.72%，特异性为 72.73%。
结论
血清 PTX3 在 PAA 中的诊断能力仅为中等，因此不能将其视为明确的诊断测试。PTX3 在复杂和非复杂 PAA 之间的鉴别能力较差。这些与目前报道的结果相反的发现应通过未来设计合理的前瞻性研究进行验证。
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