Department of General Surgery, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Department of General Surgery, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Surgeon. 2023 Dec;21(6):361-368. doi: 10.1016/j.surge.2023.05.001. Epub 2023 May 18.
To investigate the risk factors and the value of clinical prediction model for complicated appendicitis (CA) during pregnancy.
Prospective analysis of pregnant patients who underwent appendectomy at a single tertiary care center between February 2020 and February 2023 and who ultimately had pathologically confirmed acute appendicitis (AA). According to intraoperative conditions and postoperative pathology, they were divided into the CA group and the uncomplicated appendicitis (UA) group. The two groups of patients were then compared in terms of demographic characteristics, disease features, ancillary tests and predictive models of acute appendicitis.
A total of 90 patients with AA in pregnancy were included, 21 of whom had CA in pregnancy and 69 had UA in pregnancy. Multivariate regression analysis showed that gestational week, neutrophil ratio and C-reactive protein (CRP) were independent risk factors for CA during pregnancy. Relative to the first trimester, the third trimesters had an increased risk of complicated appendicitis (OR = 12.48, 95% CI: 1.56-99.57, P = 0.017). Neutrophil ratio ≥85.30% (OR = 24.54, 95% CI: 2.59-232.72, P = 0.005) and CRP ≥34.26 mg/L (OR = 7.86, 95% CI: 2.18-28.38, P = 0.002) had a significantly increased risk of CA. The AIR and AAS score models were statistically different between the two groups, but with a lower sensitivity of 52.38% and 42.86%, respectively.
The third trimesters, neutrophil ratio ≥85.30% and CRP ≥34.26 mg/L may be key predictors of CA in pregnancy. The current scoring model is inadequate to identify complex appendicitis in pregnancy and further research is needed.
探讨妊娠期复杂性阑尾炎（CA）的危险因素及临床预测模型的价值。
前瞻性分析 2020 年 2 月至 2023 年 2 月在一家三级医疗中心接受阑尾切除术且最终经病理证实为急性阑尾炎（AA）的妊娠患者。根据术中情况和术后病理，将其分为 CA 组和非复杂性阑尾炎（UA）组。比较两组患者的人口统计学特征、疾病特征、辅助检查和急性阑尾炎预测模型。
共纳入 90 例妊娠合并 AA 患者，其中 21 例为妊娠合并 CA，69 例为妊娠合并 UA。多变量回归分析显示，孕周、中性粒细胞比例和 C 反应蛋白（CRP）是妊娠期 CA 的独立危险因素。与孕早期相比，孕晚期发生复杂性阑尾炎的风险增加（OR=12.48，95%CI：1.56-99.57，P=0.017）。中性粒细胞比例≥85.30%（OR=24.54，95%CI：2.59-232.72，P=0.005）和 CRP≥34.26mg/L（OR=7.86，95%CI：2.18-28.38，P=0.002）发生 CA 的风险显著增加。两组间 AIR 和 AAS 评分模型存在统计学差异，但敏感性分别为 52.38%和 42.86%。
孕晚期、中性粒细胞比例≥85.30%和 CRP≥34.26mg/L 可能是妊娠期 CA 的关键预测指标。目前的评分模型不足以识别妊娠期复杂性阑尾炎，需要进一步研究。
