Calvo Rigual F, Sendra Esteve S, Mialaret Lahiguera A, Montagud Beltrán E, Llanes Domingo S, Medrano González J
Servicio de Pediatria, Hospital Lluis Alcanyís, Valencia.
An Esp Pediatr. 1998 Apr;48(4):376-80.
The aim of this study was to evaluate the usefulness of C-reactive protein values in the diagnosis of acute appendicitis, either as a single test or in combination with total white cell count.
Two hundred and thirty-one children with suspected appendicitis were analyzed. C-reactive protein and total white cell counts were measured and compared with the duration of symptoms and histological diagnosis. Both tests were compared by receiver-operating characteristic curves and the probability for the use of both tests together was calculated.
Ninety out of 231 patients had abdominal pain that did not demand surgery. One hundred and forty-one children had histologically confirmed appendicitis (subgroups: 101 acute, 25 gangrenous and 15 perforated appendices). Mean C-reactive protein levels at admission were 25.1, 55 and 66.7 mg/L, respectively in these histological subgroups and 14.9 mg/L in the non-appendicitis group (p < 0.001). The total white cell count was also statistically significant. Both tests were equally valuable in patients whose symptoms had a duration of more than 12 hours. The total white cell count was more valuable in patients with less than 12 hours of symptoms. The likelihood ratio for appendicitis was 2.72 for a C-reactive protein greater than 20 mg/l and a total white cell count above 15,000/mm3. The likelihood ratio of not having appendicitis was 0.37 when both tests were below these values.
Measurement of C-reactive protein is useful in the diagnosis of acute appendicitis, mainly in cases with more than 12 hours of evolution. The combined tests improved the predictive values.
本研究旨在评估C反应蛋白值在急性阑尾炎诊断中的作用，无论是单独检测还是与白细胞总数联合检测。
对231例疑似阑尾炎的儿童进行分析。测量C反应蛋白和白细胞总数，并与症状持续时间和组织学诊断结果进行比较。通过受试者工作特征曲线对这两项检测进行比较，并计算同时使用这两项检测的概率。
231例患者中有90例腹痛无需手术治疗。141例儿童经组织学证实为阑尾炎（亚组：101例急性阑尾炎、25例坏疽性阑尾炎和15例穿孔性阑尾炎）。这些组织学亚组入院时的平均C反应蛋白水平分别为25.1、55和66.7mg/L，非阑尾炎组为14.9mg/L（p<0.001）。白细胞总数也有统计学意义。对于症状持续时间超过12小时的患者，这两项检测同样有价值。对于症状持续时间少于12小时的患者，白细胞总数更有价值。当C反应蛋白大于20mg/l且白细胞总数高于15,000/mm3时，阑尾炎的似然比为2.72。当两项检测结果均低于这些值时，无阑尾炎的似然比为0.37。
C反应蛋白检测对急性阑尾炎的诊断有帮助，主要适用于病程超过12小时的病例。联合检测提高了预测价值。
