外科理论与实践

外科理论与实践 ›› 2019, Vol. 24 ›› Issue (05): 458-464.doi: 10.16139/j.1007-9610.2019.05.017

• 论著 • 上一篇    下一篇

急性阑尾炎炎性标志物联合CT分级与病理类型相关性研究

王健1a, 潘欣1b, 唐翠1c, 马乐1a, 曾思良2   

  1. 1.同济大学附属杨浦医院a.普外科,b.中心实验室,c.放射科,上海 200090;
    2.上海师范大学天华学院康复治疗学系,上海 201815
  • 收稿日期:2018-05-10 出版日期:2019-10-05 发布日期:2019-10-05
  • 通讯作者: 潘欣,E-mail: xinpanpx@163.com
  • 基金资助:
    国家自然科学基金（30972633）; 上海市卫生健康委员会科研项目（201640253）; 上海市杨浦区科学技术委员会杨浦区卫生健康委员会科研项目（YP15M19）; 同济大学附属杨浦医院学科带头人攀登计划（YE2201608）; 同济大学附属杨浦医院院级项目（SE1201746）

Acute appendicitis: relationship between blood inflammatory markers with CT grading and pathological classification

WANG Jian1a, PAN Xin1b, TANG Cui1c, MA Le1a, ZENG Siliang2   

  1. 1a. Department of General Surgery, 1b. Central Laboratory, 1c. Department of Radiology, Yangpu Hospital, Tongji University, Shanghai 200090, China;
    2. Department of Rehabilitation Therapy, Shanghai Normal University Tianhua College, Shanghai 201815, China
  • Received:2018-05-10 Online:2019-10-05 Published:2019-10-05

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摘要： 目的：探讨急性阑尾炎病人术前血液炎性标志物联合腹部螺旋CT检查与阑尾炎病理类型的相关性,以提高急性阑尾炎的早期诊断水平。方法：回顾性分析133例急性阑尾炎病人的血液炎性标志物检测结果,并与腹部CT检查和病理组织分析结果进行分析比较。结果：急性阑尾炎病理检查为单纯性阑尾炎14例,化脓性108例,坏疽性或穿孔性11例。病理分级与腹部CT检查分级显著相关（R=0.374,P<0.001）。血液炎性标志物白细胞（white blood cell,WBC）计数、中性粒细胞百分比（neutrophil percentage,N%）、C反应蛋白（C reaction protein,CRP）浓度与CT检查阑尾直径同时升高（WBC≥12.45×109/L,N%≥81.80%,CRP浓度≥22.56 mg/L,阑尾直径≥8.75 mm）有助于鉴别诊断单纯性阑尾炎与坏疽性或穿孔性阑尾炎。CRP浓度高于截断值 54.00 mg/L有助于鉴别诊断坏疽性或穿孔性阑尾炎与单纯性或化脓性阑尾炎。CT检查≥1级的病人,呈现WBC计数、N%、CRP浓度与阑尾直径任一指标升高的特征。CT检查≥2级病人,CRP浓度与阑尾直径都升高;CT检查≥3级病人,呈现WBC计数、N%与CRP浓度都升高。结论：检查坏疽性或穿孔性阑尾炎病人血液CRP浓度明显升高,有助于坏疽性或穿孔性阑尾炎与单纯性或化脓性阑尾炎的鉴别诊断。WBC计数、N%、CRP浓度联合CT检查阑尾直径,有助于急性阑尾炎的早期鉴别诊断。

关键词: 急性阑尾炎, 血液炎性标志物, 腹部CT平扫, 阑尾直径, 病理类型

Abstract: Objective To explore the relationship between blood inflammatory markers combined with abdominal computed tomography (CT) grading and pathological classification in the patient with acute appendicitis for early diagnosis of acute appendicitis. Methods The clinical data of 133 patients of acute appendicitis were retrospectively analyzed with blood inflammatory markers, abdominal CT scan and pathological classification. Results Pathological classification of patients including 14 cases with uncomplicated appendicitis, 108 cases with suppurative appendicitis and 11 cases with gangrenous or perforated appendicitis correlated abdominal CT grading significantly (R=0.374,P<0.001). Blood inflammatory markers, which were white blood cell (WBC) count, neutrophil percentage (N%), and CRP concentration, and appendiceal diameter from CT scan increased simultaneously. The indexes (WBC≥12.45×109/L,N%≥81.80%,CRP≥22.56 mg/L,and appendiceal diameter ≥8.75 mm) could help differentiation of uncomplicated acute appendicitis from gangrenous or perforated appendicitis. CRP concentration above cut-points 54.00 mg/L differentiated the diagnosis of patients with gangrenous or perforated appendicitis from suppurative or uncomplicated appendicitis. The patients with CT grade 1 were determined by any one of the indicators (WBC, N%, CRP and appendix diameter) exceeds the normal value. The patients with CT grade 2 presented elevation of both CRP and appendiceal diameter. The patients with CT grade 3 and 4 presented all elevation of WBC, N% and CRP levels. Conclusions Very high concentration levels of CRP in the patients with acute appendicitis might be useful for differential diagnose between gangrenous or perforated appendicitis and uncomplicated or suppurative appendicitis. Combined observation of WBC, N%, CRP or appendiceal diameter improves the accuracy of early diagnosis of acute appendicitis.

Key words: Acute appendicitis, Blood inflammatory marker, Abdominal computed tomography scan, Appendiceal diameter, Pathological classification

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