Miettinen A K, Heinonen P K, Laippala P, Paavonen J
Department of Biomedical Sciences, University of Tampere, Finland.
Am J Obstet Gynecol. 1993 Nov;169(5):1143-9. doi: 10.1016/0002-9378(93)90271-j.
The objective of the study was to evaluate the test performance of erythrocyte sedimentation rate and serum C-reactive protein in assessing the severity of acute pelvic inflammatory disease and to determine clinically useful cutoff levels to discriminate mild from severe pelvic inflammatory disease.
The study population consisted of 72 women with acute pelvic inflammatory disease verified by laparoscopy and endometrial histopathologic studies; 37 patients had mild and 35 had severe pelvic inflammatory disease. Cutoff levels for erythrocyte sedimentation rate and C-reactive protein were determined to reach best sensitivity and specificity to discriminate between severe and mild disease. Clinical and microbiologic data were analyzed by chi 2, or t test. Logistic regression analysis was used to analyze risk factors for severe pelvic inflammatory disease.
Patients with severe pelvic inflammatory disease had higher erythrocyte sedimentation rates and C-reactive protein levels than did those with mild disease. In detecting severe disease an erythrocyte sedimentation rate > or = 40 mm/hr and C-reactive protein levels > or = 60 mg/L had a sensitivity of 97%, a specificity of 61%, a negative predictive value of 96%, and a positive predictive value of 70%. All patients with tuboovarian abscess or perihepatitis and six of seven patients who had anaerobic bacteria isolated from the fallopian tubes tested positive with these cutoff levels.
Combined use of erythrocyte sedimentation rate and C-reactive protein levels is useful in assessing the severity of acute pelvic inflammatory disease and augments the clinical decision making regarding treatment.
本研究的目的是评估红细胞沉降率和血清C反应蛋白在评估急性盆腔炎严重程度方面的检测性能，并确定区分轻度与重度盆腔炎的临床有用临界值。
研究人群包括72例经腹腔镜检查和子宫内膜组织病理学研究证实患有急性盆腔炎的女性；37例患者为轻度盆腔炎，35例为重度盆腔炎。确定红细胞沉降率和C反应蛋白的临界值，以达到区分重度和轻度疾病的最佳敏感性和特异性。临床和微生物学数据采用卡方检验或t检验进行分析。采用逻辑回归分析来分析重度盆腔炎的危险因素。
重度盆腔炎患者的红细胞沉降率和C反应蛋白水平高于轻度盆腔炎患者。在检测重度疾病时，红细胞沉降率≥40mm/小时和C反应蛋白水平≥60mg/L的敏感性为97%，特异性为61%，阴性预测值为96%，阳性预测值为70%。所有患有输卵管卵巢脓肿或肝周围炎的患者以及7例从输卵管分离出厌氧菌的患者中有6例在这些临界值下检测呈阳性。
联合使用红细胞沉降率和C反应蛋白水平有助于评估急性盆腔炎的严重程度，并有助于增强关于治疗的临床决策。
