Grönroos J M, Forsström J J, Irjala K, Nevalainen T J
Department of Surgery, University of Turku, Finland.
Clin Chem. 1994 Sep;40(9):1757-60.
We compared the predictive value of determining group II phospholipase A2 (PLA2) in serum for diagnosing acute appendicitis with the predictive values of white blood cell count (WBC) and measurement of C-reactive protein (CRP). In this prospective study, we included 186 patients who were undergoing appendectomy after clinical diagnoses of acute appendicitis. The performance of each test was measured by receiver-operating characteristic curves. WBC was the test of choice in diagnosing uncomplicated acute appendicitis. However, in contrast to CRP and PLA2, which increased in patients with protracted inflammation, there was not a concomitant increase in WBC. Therefore, especially CRP, but also PLA2, were better indicators of appendiceal perforation or abscess formation than was WBC. Increased WBC, CRP, and PLA2 values did not unequivocally corroborate the clinical suspicion of appendicitis, but if all three values were within normal limits, acute appendicitis could be excluded with a 100% predictive value. PLA2 values showed a highly significant correlation with CRP but not with WBC values, which supports the view that PLA2 represents an acute-phase reactant.
我们将血清中II组磷脂酶A2（PLA2）测定对急性阑尾炎的预测价值与白细胞计数（WBC）及C反应蛋白（CRP）测定的预测价值进行了比较。在这项前瞻性研究中，我们纳入了186例临床诊断为急性阑尾炎后接受阑尾切除术的患者。每项检测的性能通过受试者工作特征曲线进行测定。WBC是诊断单纯性急性阑尾炎的首选检测方法。然而，与CRP和PLA2不同，CRP和PLA2在炎症迁延的患者中会升高，而WBC却没有相应升高。因此，尤其是CRP，PLA2也是比WBC更好的阑尾穿孔或脓肿形成的指标。WBC、CRP和PLA2值升高并不能明确证实临床对阑尾炎的怀疑，但如果这三个值均在正常范围内，则可以100%的预测价值排除急性阑尾炎。PLA2值与CRP高度相关，但与WBC值无关，这支持了PLA2代表急性期反应物的观点。
