Gurleyik E, Gurleyik G, Unalmişer S
Department of Surgery, Haydarpasa Numune Hospital, Istanbul, Turkey.
Dis Colon Rectum. 1995 Dec;38(12):1270-4. doi: 10.1007/BF02049151.
Diagnosis of acute appendicitis is established generally by the surgeon's clinical impression. Today, negative laparotomy rate because of clinical diagnosis is still 15 to 25 percent.
This study was designed to determine the accuracy of C-reactive protein (CRP) measurements in the diagnosis of acute appendicitis and to compare it with the surgeon's clinical diagnosis.
One hundred eight consecutive patients were studied prospectively. Depending on results of the examination by a surgeon, patients underwent surgery for acute appendicitis. Serum CRP measurements were performed before the operations but were not taken into account for the decision of laparotomy to compare it with the surgeon's clinical diagnosis.
Histopathologic findings confirmed acute appendicitis in 90 patients. Normal appendixes were removed in the remaining 18 patients. Mean serum CRP value was 5 (range, 0-12.6) mg/l in patients with normal appendix, 33.8 (range, 5-85.1) mg/l in patients with nonperforated appendicitis, and 128.5 (range, 79.2-230) mg/l in patients with perforated appendixes. These differences were highly significant (P < 10(-6)). Serum CRP levels were normal in three patients with acute appendicitis. Thus, the false-negative rate of CRP was 3 percent. Of 18 patients with normal appendectomy serum CRP levels were slightly elevated in two patients. We determined, therefore, a false-positive rate of CRP as 11 percent. CRP levels were false-negative in three patients and false-positive in two patients. Thus, CRP levels were true (positive or negative) in the remaining 103 patients. On the other hand, the diagnosis depending on surgeon's clinical impression was true in 90 patients and false in 18 patients. This difference was statistically significant (P = 0.0035). In the present study the sensitivity, specificity, and accuracy of serum CRP measurements were calculated as 93.5, 80, and 91 percent, respectively.
We found that elevated serum CRP levels support surgeon's clinical diagnosis. We recommend CRP measurement as a routine laboratory test in patients with suspected diagnosis of acute appendicitis.
急性阑尾炎的诊断通常由外科医生的临床判断来确定。如今，因临床诊断导致的阴性剖腹手术率仍为15%至25%。
本研究旨在确定C反应蛋白（CRP）检测在急性阑尾炎诊断中的准确性，并将其与外科医生的临床诊断进行比较。
对108例连续患者进行前瞻性研究。根据外科医生的检查结果，患者接受急性阑尾炎手术。在手术前进行血清CRP检测，但在决定是否进行剖腹手术时不考虑该结果，以便与外科医生的临床诊断进行比较。
组织病理学检查结果证实90例患者患有急性阑尾炎。其余18例患者切除的阑尾正常。阑尾正常的患者血清CRP平均值为5（范围0 - 12.6）mg/l，非穿孔性阑尾炎患者为33.8（范围5 - 85.1）mg/l，穿孔性阑尾炎患者为128.5（范围79.2 - 230）mg/l。这些差异具有高度统计学意义（P < 10⁻⁶）。3例急性阑尾炎患者的血清CRP水平正常。因此，CRP的假阴性率为3%。在18例阑尾切除正常的患者中，2例患者的血清CRP水平略有升高。因此，我们确定CRP的假阳性率为11%。3例患者的CRP水平为假阴性，2例患者为假阳性。因此，其余103例患者的CRP水平为真（阳性或阴性）。另一方面，根据外科医生临床判断的诊断在90例患者中为真，在18例患者中为假。这种差异具有统计学意义（P = 0.0035）。在本研究中，血清CRP检测的敏感性、特异性和准确性分别计算为93.5%、80%和91%。
我们发现血清CRP水平升高支持外科医生的临床诊断。我们建议对疑似急性阑尾炎的患者进行CRP检测作为常规实验室检查。
