Zhang Qian, Zhao Hongwei, Wang Fangli, Li Wenqiang, Zhang Peng
Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, P.R. China.
Department of General Surgery, Aerospace Center Hospital, School of Clinical Medicine, Peking University, Beijing 100039, P.R. China.
Biomed Rep. 2024 Mar 15;20(5):77. doi: 10.3892/br.2024.1765. eCollection 2024 May.
There are two types of treatment for acute appendicitis (AA): surgery and antibiotic therapy. Some patients with complex appendicitis are treated with surgery; however, for uncomplex appendicitis, most could be treated effectively with antibiotics instead. How to distinguish complex appendicitis from uncomplex appendicitis before surgery is currently unknown. The present study aimed to assess the efficacy of the laboratory parameters to diagnose complicated appendicitis. Data from 1,514 cases with acute appendicitis who were admitted to Beijing Tsinghua Changgung Hospital and Beijing Aerospace General Hospital (both Beijing, China) from January 2016 to September 2021 were retrospectively analyzed. All cases were divided into uncomplicated and complicated appendicitis. Independent variables were analyzed by uni- and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curve analysis was used to identify significant parameters in the multivariate logistic regression analysis. Cut-off values, sensitivity, specificity and accuracy with area under the curve (AUC)>0.600 were considered significant parameters. Significant differences were found in age (P<0.001), body temperature (P<0.001), white blood cell (WBC) count (P<0.001), C-reactive protein (CRP; P<0.001), neutrophil count (P<0.001), neutrophil-to-lymphocyte ratio (NLR, P=0.019), platelet-to-lymphocyte ratio (PLR, P<0.001), platelet count (P<0.001), coefficient of variation (CV) and standard deviation (SD) of red blood cell distribution width (RDW); both P<0.001), mean platelet volume (MPV, P<0.001) and total (P<0.001) and direct bilirubin (P<0.001) between the two groups. CRP, neutrophil count, NLR, PLR, platelet count, RDW-CV, RDW-SD, MPV and direct bilirubin levels were found as the independent variables to diagnose complicated appendicitis. In patients with acute appendicitis, CRP >22.95 mg/l, NLR >5.7, serum direct bilirubin >6.1 mmol/l and RDW-SD>17.7 fl were significantly associated with complicated appendicitis.
急性阑尾炎（AA）有两种治疗方式：手术和抗生素治疗。一些复杂阑尾炎患者接受手术治疗；然而，对于非复杂阑尾炎，大多数患者可以用抗生素有效治疗。目前尚不清楚如何在手术前区分复杂阑尾炎和非复杂阑尾炎。本研究旨在评估实验室参数对诊断复杂性阑尾炎的有效性。回顾性分析了2016年1月至2021年9月期间在北京清华长庚医院和北京航天总医院（均位于中国北京）收治的1514例急性阑尾炎患者的数据。所有病例分为非复杂性阑尾炎和复杂性阑尾炎。通过单因素和多因素逻辑回归分析对自变量进行分析。采用受试者工作特征（ROC）曲线分析来确定多因素逻辑回归分析中的显著参数。曲线下面积（AUC）>0.600的截断值、敏感性、特异性和准确性被视为显著参数。两组在年龄（P<0.001）、体温（P<0.001）、白细胞（WBC）计数（P<0.001）、C反应蛋白（CRP；P<0.001）、中性粒细胞计数（P<0.001）、中性粒细胞与淋巴细胞比值（NLR，P=0.019）、血小板与淋巴细胞比值（PLR，P<0.001）、血小板计数（P<0.001）、红细胞分布宽度（RDW）的变异系数（CV）和标准差（SD）；两者P<0.001）、平均血小板体积（MPV，P<0.001）以及总胆红素（P<0.001）和直接胆红素（P<0.001）方面存在显著差异。发现CRP、中性粒细胞计数、NLR、PLR、血小板计数、RDW-CV、RDW-SD、MPV和直接胆红素水平是诊断复杂性阑尾炎的自变量。在急性阑尾炎患者中，CRP>22.95mg/l、NLR>5.7、血清直接胆红素>6.1mmol/l和RDW-SD>17.7fl与复杂性阑尾炎显著相关。
