血清C反应蛋白、白介素-6和降钙素原对小儿急性复杂性阑尾炎的诊断价值研究

目的探索血清C反应蛋白(C-reactive protein,CRP)、白介素-6(interleukin 6,IL-6)和降钙素原(procalcitonin,PCT)水平对小儿急性复杂性阑尾炎的诊断价值。方法以2016年1月至2017年5月包头市第四医院小儿外科收治并进行手术治疗的96例急性阑尾炎患者为研究对象,分为两组:单纯性阑尾炎组30例,复杂性阑尾炎(包括化脓性阑尾炎及坏疽性阑尾炎)组66例,两组患者年龄、性别、体重差异均无统计学意义(P>0.05),检测两组患者术前血清CRP、IL-6、和PCT浓度,并绘制ROC曲线分析CRP、IL-6和PCT对小儿急性复杂性阑尾炎的诊断价值。结果复杂性阑尾炎组CRP、IL-6及PCT水平均显著高于单纯性阑尾炎组(P<0.05);以手术后病理结果为金标准,CRP、PCT、IL-6及三者联合检验ROC曲线下面积别为0.906(95%置信区间:0.829~0.956),0.953(95%置信区间:0.889~0.986),0.765(95%置信区间:0.668~0.846),0.973(95%置信区间:0.971~0.995)。曲线下面积值由大到小排序:PCT+CRP+IL-6>PCT>CRP>IL-6,通过两两比较发现,联合检验曲线下面积与CRP、IL-6单独检验曲线下面积比较差异具有统计学意义(Z=2.932,P=0.003;Z=3.854,P=0.0001);联合检验曲线下面积与PCT单独检验曲线下面积比较差异无统计学意义(Z=1.861,P=0.063);CRP与PCT单独检验曲线下面积差异无统计学意义(Z=1.668,P=0.095),IL-6单独检验与CRP单独检验、PCT单独检验比较曲线下面积差异具有统计学意义(Z=2.312,P=0.021;Z=3.371,P=0.001);得到最佳临界点分别为11.47(95%置信区间:11.42~14.48)mg/L,0.87(95%置信区间:0.63~0.98)ng/L,88.60(95%置信区间:87.12~170.83)pg/mL。结论CRP、IL-6和PCT有助于临床医师对阑尾炎严重程度进行早期判断,从而早期争取家长配合,尽早手术治疗并减少并发症的发生。

Applicable value of serum c-reactive protein,interleukin 6 and procalcitonin in acute complex pediatric appendicitis

Objective To explore the correlation between serum C-reactive protein(CRP),interleukin-6(IL-6),procalcitonin(PCT)and acute complex appendicitis in children and examine their diagnostic values.Methods A total of 96 hospitalized children with acute appendicitis underwent operations from 2016 to 2017.They were divided into two groups of simple appendicitis(n=30,A1)and complex suppurative/gangrenous appendicitis(n=60,A2).The preoperative serum concentrations of CRP,IL-6,and PCT were measured and compared for two groups.The receiver operating characteristic(ROC)curves were plotted for analyzing the diagnostic values of CRP,IL-6 and PCT in children with acute complex appendicitis.Results No statistical significance existed in age,gender or weight between two groups(P>0.05).The levels of CRP,IL-6 and PCT were significantly higher in group A2 than those in group A1(P<0.05).ROC curve was plotted according to the postoperative pathological results for analyzing the diagnostic efficiency of CRP,PCT and IL-6 for complicated appendicitis.AUC of CRP,PCT,IL-6 and their combined test were 0.906(95%CI:0.829-0.956),0.953(95%CI:0.889-0.986),0.765(95%CI:0.668-0.846)and 0.973(95%CI:0.971-0.995)respectively.Value of AUC was PCT+CRP+IL-6>PCT>CRP>IL-6.AUC of combined test was statistically different from that of CRP/IL-6(Z=2.932,P=0.003;Z=3.854,P=0.0001).No statistical difference existed between AUC of combined test and that of PCT(Z=1.861,P=0.063)or between AUC of CRP and that of PCT(Z=1.668,P=0.095);and statistical difference existed between AUC of IL-6 and that of CRP/PCT(Z=2.312,P=0.021;Z=3.371,P=0.001).The obtained optimal critical points were 11.47(95%CI:11.42-14.48)mg/L,0.87(95%CI:0.63-0.98)ng/L and 88.60(95%CI:87.12-170.83)pg/ml respectively.Conclusion Clinicians can judge the severity of appendicitis during an early stage by CRP,IL-6 and PCT so as to win the cooperation of parents,perform operations as early as possible and reduce the occurrence of complications.