临床常用炎症指标对不同年龄段儿童复杂性阑尾炎的预测价值

王扎根; 黄家虎; 王天明; 李廷俊

doi:10.12467/j.issn.2096-3882.20240843

临床常用炎症指标对不同年龄段儿童复杂性阑尾炎的预测价值

Predictive value of common inflammatory markers for complex appendicitis in children of different age groups

摘要

摘要: 目的探讨临床常用炎症指标对不同年龄段儿童复杂性阑尾炎(CA)的预测价值。方法回顾性纳入2018年1月—2021年12月上海交通大学医学院附属儿童医院861例确诊为急性阑尾炎的患儿,根据术后病理类型分为CA组和非复杂性阑尾炎组,并根据患儿年龄分为小年龄组(<60月龄)和大年龄组(≥60月龄)。分别对两年龄组行单因素分析及多因素logistic回归分析,筛选出不同年龄组CA的独立危险因素;通过受试者工作特征(ROC)曲线评估不同炎症指标的预测价值。结果 861例患儿中,男性526例,女性335例;大年龄组721例,小年龄组140例。单因素及多因素logistic回归分析显示降钙素原(PCT)、C-反应蛋白(CRP)是预测小年龄组患儿CA发生的独立危险因素,D-二聚体 (D-D)、CRP、PCT、白细胞计数(WBC)、中性粒细胞淋巴细胞比值(NLR)均为预测大年龄组患儿CA发生的独立危险因素(P<0.05)。ROC曲线显示,小年龄组PCT、CRP及两者联合预测CA的ROC曲线下面积(AUC)分别为0.809(95%CI:0.773~0.915)、0.842(95%CI:0.707~0.860)、0.860(95%CI:0.776~0.944);大年龄组PCT、CRP、D-D、WBC、NLR及联合预测CA的AUC值分别为0.767(95%CI:0.723~0.811)、0.770(95%CI:0.726~0.814)、0.757 (95%CI:0.712~0.801)、0.604(95%CI:0.553~0.656)、0.677(95%CI:0.630~0.723)、0.850(95%CI:0.815~0.884)。结论大年龄组与小年龄组CA患儿在炎症指标方面存在明显差异,其CA独立危险因素各有不同;2个年龄组中联合炎症指标预测CA的效能均优于单一指标。

Abstract: Objective To explore the predictive value of common clinical inflammatory markers for complex appendicitis in children of different age groups. Methods A retrospective analysis was conducted on 861 patients who were diagnosed with acute appendicitis at Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University from January 2018 to December 2021. According to postoperative pathology, the patients were divided into two groups: complex appendicitis and non-complex appendicitis. Furthermore, the patients were also divivided into a younger age group (<60 months) and an older age group (≥60 months). Univariate and multivariate logistic regression were performed for each age group to identify independent risk factors for complex appendicitis. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of different inflammatory markers. Results Among the 861 patients, 526 were male and 335 were female; 721 were in the older age group, and 140 were in the younger age group. Univariate and multivariate logistic regression analysis showed that procalcitonin (PCT) and C-reactive protein (CRP) were independent risk factors for complex appendicitis in the younger age group, while D-dimer (D-D), CRP, PCT, white blood cell count (WBC), and neutrophil-to-lymphocyte ratio (NLR) were independent risk factors for complex appendicitis in the older age group (P<0.05). ROC curves showed that the area under the curve (AUC) for PCT, CRP, and their combination in predicting complex appendicitis in the younger age group were 0.809 (95%CI:0.773-0.915), 0.842 (95%CI:0.707-0.860), and 0.860 (95%CI:0.776-0.944), respectively. In the older age group, the AUC values for PCT, CRP, D-D, WBC, NLR, and their combination in predicting complex appendicitis were 0.767 (95%CI:0.723-0.811), 0.770 (95%CI:0.726-0.814), 0.757 (95%CI:0.712-0.801), 0.604 (95%CI:0.553-0.656), 0.677 (95%CI:0.630-0.723), and 0.850 (95%CI:0.815-0.884), respectively. Conclusions There are significant differences in inflammatory markers between children in the older and younger age groups with complex appendicitis, with different independent risk factors in each age group. The combination of inflammatory markers provides better predictive value for complex appendicitis than each marker alone in both age groups.

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