Sánchez Echániz J, Luis García M, Vázquez Ronco M A, Mintegui Raso S, Benito Fernández J, López Alvarez-Buhilla P
Sección de Urgencias de Pediatría, Hospital Infantil de Cruces, Vizcaya.
An Esp Pediatr. 1998 May;48(5):470-4.
The aim of this study was to evaluate the accuracy of C-reactive protein (CRP) measurements in the diagnosis of suspected acute appendicitis (AA) during childhood.
A prospective study of 195 consecutive children, aged between 2 and 14 years and suspected of having AA, that attended a pediatric emergency room was carried out. We obtained a careful patient history, physical signs, blood test results, final diagnosis and the histological findings in the cases who underwent appendectomy (classified as normal appendix, simple appendicitis (SA) or gangrenous appendicitis (GA).
The final diagnoses and their frequencies were: AA (94), non-specific abdominal pain (80), mesenteric lymphadenitis (6) and others (15). Appendectomies were performed in 103 cases with 94 cases being AA (91.3%) and of these 51 SA and 43 GA. The average values of CRP (mg/l) were: AA: 30, SA: 16, GA: 67, non-specific abdominal pain: 15, and mesenteric lymphadenitis: 44 (p < 0.01). The values of AG were statistically higher than those of SA (p = 0.0000). The ROC curve of these data determined the best cut-off levels for AA to be 30 (sensitivity: 0.43, specificity: 0.92, predictive value of a positive result: 0.87 and predictive value of a negative result: 0.58).
本研究旨在评估C反应蛋白（CRP）检测在儿童疑似急性阑尾炎（AA）诊断中的准确性。
对195名年龄在2至14岁之间、疑似患有AA且前往儿科急诊室就诊的连续儿童进行了一项前瞻性研究。我们仔细收集了患者病史、体征、血液检测结果、最终诊断以及接受阑尾切除术患者的组织学检查结果（分为正常阑尾、单纯性阑尾炎（SA）或坏疽性阑尾炎（GA））。
最终诊断及其频率如下：AA（94例）、非特异性腹痛（80例）、肠系膜淋巴结炎（6例）和其他（15例）。103例患者接受了阑尾切除术，其中94例为AA（91.3%），这94例中51例为SA，43例为GA。CRP（mg/l）的平均值分别为：AA：30、SA：16、GA：67、非特异性腹痛：15、肠系膜淋巴结炎：44（p < 0.01）。GA组的值在统计学上高于SA组（p = 0.0000）。这些数据的ROC曲线确定AA的最佳截断值为30（敏感性：0.43，特异性：0.92，阳性结果预测值：0.87，阴性结果预测值：0.58）。
1）AA患者的CRP值高于其他腹痛病因患者。然而，该值不应作为拒绝手术的依据，因为SA患者的CRP值通常正常。2）当疑似AA患者的CRP值> 40 mg/L时，应考虑GA，因此应开始预防性使用抗生素并立即进行手术。
