C A Shashirekha, Vincent Akhil
General Surgery, Sri Devaraj Urs Medical College, Kolar, IND.
Cureus. 2024 Dec 6;16(12):e75247. doi: 10.7759/cureus.75247. eCollection 2024 Dec.
Introduction Acute appendicitis is a common surgical emergency that requires a timely and accurate diagnosis to prevent complications. Several laboratory markers have been assessed to improve the diagnostic accuracy of acute appendicitis, including C-reactive protein (CRP), white blood cell (WBC) count, and cytokines like interleukins and tumor necrosis factor-alpha. One less commonly used but potentially valuable marker is the mean platelet volume (MPV), which indicates the size of circulating platelets and has the potential to serve as a biomarker for inflammatory conditions. Methodology The study was designed as a retrospective analytical investigation to examine the role of MPV in diagnosing acute appendicitis. The retrospective design allowed the utilization of existing hospital data, ensuring that sufficient cases of acute appendicitis could be assessed without additional data collection. The calculation was based on statistical parameters, including the standard deviations from previous studies, critical values at a 5% significance level, and an 80% test power, arriving at a minimum required sample size of approximately 100 to ensure adequate statistical power for meaningful conclusions. Results The study found that patients with acute appendicitis had significantly higher MPV compared to the normal reference value of 8.9 fL. The average MPV in the patient group was 10.25 fL, which was statistically higher than the reference value ( < 0.001). Furthermore, the study revealed that MPV levels were even higher in patients with more severe forms of appendicitis, such as perforated or gangrenous appendicitis. The average MPV for the inflamed appendicitis group was 10.13 fL, while the average MPV for the perforated or gangrenous group was 11.26 fL, a statistically significant difference ( < 0.001). Conclusions The study demonstrates that MPV is a potentially valuable marker for diagnosing acute appendicitis and assessing its severity, particularly when used in combination with other biomarkers like neutrophil-to-lymphocyte ratio (NLR) and WBC count. Elevated MPV in complicated cases of appendicitis, such as perforated or gangrenous appendicitis, suggests that MPV may aid in identifying high-risk patients who require urgent surgical intervention. While MPV alone may not be as reliable as NLR in predicting appendicitis severity, its inclusion in a multi-biomarker approach could improve clinical decision-making.
引言
急性阑尾炎是一种常见的外科急症，需要及时准确的诊断以预防并发症。已经评估了几种实验室指标以提高急性阑尾炎的诊断准确性，包括C反应蛋白（CRP）、白细胞（WBC）计数以及白细胞介素和肿瘤坏死因子-α等细胞因子。一种较少使用但可能有价值的指标是平均血小板体积（MPV），它表示循环血小板的大小，有可能作为炎症状态的生物标志物。
方法
本研究设计为一项回顾性分析调查，以检验MPV在诊断急性阑尾炎中的作用。回顾性设计允许利用现有的医院数据，确保无需额外收集数据就能评估足够数量的急性阑尾炎病例。计算基于统计参数，包括先前研究的标准差、5%显著性水平下的临界值以及80%的检验效能，得出所需的最小样本量约为100，以确保有足够的统计效能得出有意义的结论。
结果
研究发现，与8.9 fL的正常参考值相比，急性阑尾炎患者的MPV显著更高。患者组的平均MPV为10.25 fL，在统计学上高于参考值（<0.001）。此外，研究表明，在更严重形式的阑尾炎患者中，如穿孔性或坏疽性阑尾炎患者，MPV水平更高。发炎性阑尾炎组的平均MPV为10.13 fL，而穿孔性或坏疽性组的平均MPV为11.26 fL，差异具有统计学意义（<0.001）。
结论
该研究表明，MPV是诊断急性阑尾炎及其严重程度的潜在有价值指标, 特别是与中性粒细胞与淋巴细胞比率（NLR）和WBC计数等其他生物标志物联合使用时。在阑尾炎的复杂病例中，如穿孔性或坏疽性阑尾炎，MPV升高表明MPV可能有助于识别需要紧急手术干预的高危患者。虽然单独的MPV在预测阑尾炎严重程度方面可能不如NLR可靠，但将其纳入多生物标志物方法中可以改善临床决策。
