降钙素原对儿童急性阑尾炎严重程度的预测价值

目的 评价降钙素原（PCT）对儿童急性阑尾炎严重程度的预测价值.方法 收集2011年10月至2012年3月我们收治的93例诊断为急性阑尾炎的患儿临床资料,包括年龄、性别、入院时PCT及CRP、并发症（腹腔脓肿、肠梗阻）、住院时间等.根据手术所见或病理检查结果将患儿分为急性阑尾炎组和急性阑尾炎伴局限性或弥漫性腹膜炎组.结果 急性阑尾炎组53例,腹膜炎组40例.腹膜炎组出现并发症的比例高于急性阑尾炎组,住院时间较长,且PCT、CRP水平显著高于急性阑尾炎组（PCT：0.43 vs 3.37 ng/mL,P＜0.001,CRP：3.0vs13.8 mg/L,P＜0.001）.在诊断腹膜炎的敏感性、特异性、阳性预测值、阴性预测值方面,当PCT以0.93 ng/mL为阈值时,分别为85.0％、91.6％、88.3％、89.0％,而CRP以4.05 mg/L为阈值时,分别为90.0％、67.9％、67.9％、90.0％.结论 入院时PCT及CRP对儿童急性阑尾炎的严重程度具有一定的预测价值,且PCT性能略优于CRP.

Procalcitonin as a predictor of severity acute appendicitis in children

Objefive To evaluate the utility of procalcitonin （PCT） as apredictor of the severity of appendicitis in children.Methods We studied 93 consecutive patients admitted with a diagnosis of acute appendicitis between October 2011 and March 2012 in HuNan children＇ s hospital and collected the datum：age,sex,PCT and CRP on admission,complications （abscess,intestinal obstruction）,and length of stay.Patients were divided into 2 groups according to the diagnosis confirmed during surgery or pathological detect（group 1,appendicitis; group 2,localized or generalized peritonitis）.Results Group 1 included 53 patients,and group 2 included 40 patients.Complications were more common in group 2,and the length of stay was longer in group 2,too.PCT and CRP values were significandy lower in group 1 than in group 2 （0.43 vs 3.37 ng/mL,P ＜0.001 and 3.0 vs 13.8 mg/L,P ＜ 0.001）.For a diagnosis of peritonitis,a PCT cutoff of 0.93 ng/mL gave a sensitivity of 85.0％,specificity of 91.6％,positive predictive value of 88.3％,and negative predictive value of 89.0％.The equivalent values for a CRP cutoff of 4.05mg/L were 90.0％,67.9％,67.9％,and 90.0％.Conclusions On admission,CRP and PCT predict the outcome of pediatric patients with acute appendicitis,and the diagnostic performance of PCT is slightly prior to CRP.