高胆红素血症在急性化脓坏疽性阑尾炎中的预测价值

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摘要目的评估高胆红素血症在急性化脓坏疽性阑尾炎诊断中的预测价值。方法选取2010年1月～2018年1月本院收治的226例急性阑尾炎患者作为研究对象，所有患者术前均进行血清总胆红素（TBil）、C-反应蛋白（CRP）、白细胞计数（WBC）检测，并根据术后病理分为单纯性阑尾炎组（51例）、急性化脓坏疽性阑尾炎组（129例）和穿孔性阑尾炎组（46例），记录所有患者的高胆红素血症发生率、血清胆红素、CRP、WBC水平，并通过Alavrdo得分预测急性化脓坏疽性阑尾炎的敏感度和特异度。结果单纯性阑尾炎组高胆红素血症发生率、术后并发症发生率、Alvardo得分、WBC、TBil、CRP水平低于化脓性坏疽性阑尾炎组及穿孔性阑尾炎组（P＜0.05），腹痛时间、术后住院时间短于化脓性坏疽性阑尾炎组及穿孔性阑尾炎组（P＜0.05）；化脓性坏疽性阑尾炎组及穿孔性阑尾炎组高胆红素血症发生率、术后并发症发生率比较，差异无统计学意义（P＞0.05）；化脓性坏疽性阑尾炎组腹痛时间、术后住院时间短于穿孔性阑尾炎组（P＜0.05），Alvardo得分、WBC、TBil、CRP 水平低于穿孔性阑尾炎组（P＜0.05）。 TBil水平＞21.3 μmol/L时，则预测急性化脓坏疽性阑尾炎的敏感度为89.5%，特异度为91.6%，阳性预测值85.7%，阴性预测值为93.8%，敏感度和特异度明显高于WBC、CRP水平和Alavrdo得分（P＜0.05）。结论高胆红素血症具有较好的预测急性化脓坏疽性阑尾炎的诊断价值。

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	陶红发
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	任鹏真
	何小宇

关键词 ：急性阑尾炎, 高胆红素血症, 敏感度, 特异度

Abstract：Objective To evaluate the predictive value of hyperbilirubinemia in the diagnosis of acute purulent gangrenous appendicitis.Methods A total of 226 patients with acute appendicitis who were admitted to our hospital from January 2010 to January 2018 were selected as research subjects,serum total bilirubin(TBil),C-reactive protein(CRP)and white blood cell count(WBC)were detected in all patients before operation,the patients were divided into simple appendicitis group (51 cases),acute pyogenic gangrenous appendicitis group (129 cases)and perforating appendicitis group (46 cases)according to postoperative pathology,the incidence of hyperbilirubinemia,serum bilirubin,CRP and WBC levels were recorded,the sensitivity and specificity of acute pyogenic gangrenous appendicitis were predicted by Alavrdo score.Results The incidence of hyperbilirubinemia,postoperative complications,Alvardo score,WBC,TBil and CRP levels in simple appendicitis group were lower than those in pyogenic gangrenous appendicitis group and perforating appendicitis group(P＜0.05),the duration of abdominal pain and postoperative hospitalization were shorter than those of pyogenic gangrenous appendicitis group and perforating appendicitis group (P＜0.05);There was no significant difference in the incidence of hyperbilirubinemia and postoperative complications between pyogenic gangrenous appendicitis group and perforating appendicitis group(P＞0.05);The duration of abdominal pain and postoperative hospitalization in pyogenic gangrenous appendicitis group were shorter than those in perforating appendicitis group (P＜0.05),alvardo scores,WBC,TBil and CRP levels were lower than those in the perforated appendicitis group(P＜0.05).The sensitivity,specificity,positive predictive value and negative predictive value of acute pyogenic gangrenous appendicitis were 89.5%,91.6%,85.7%and 93.8%respectively,when serum bilirubin level＞21.3 mol/L,sensitivity and specificity were significantly higher than those of WBC,CRP and Alavrdo scores(P＜0.05).Conclusion Hyperbilirubinemia has better predictive value in the diagnosis of acute suppurative gangrenous appendicitis.

Key words： Acute appendicitis Hyperbilirubinaemia Sensitivity Specificity

引用本文:

陶红发;赵坤;肖勇;张超;叶元礼;任鹏真;何小宇. 高胆红素血症在急性化脓坏疽性阑尾炎中的预测价值[J]. 中国当代医药, 2018, 25(29): 33-36.
TAO Hong-fa;ZHAO Kun;XIAO Yong;ZHANG Chao;YE Yuan-li;REN Peng-zhen;HE Xiao-yu. Predictive value of hyperbilirubinemia in acute suppurative gangrenous appendicitis. 中国当代医药, 2018, 25(29): 33-36.

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