纤维蛋白原在儿童急性阑尾炎穿孔中的预测价值

目的 探讨血浆纤维蛋白原水平在儿童急性阑尾炎穿孔中的预测价值。方法收集204例行手术治疗的急性阑尾炎患儿，根据病理报告结果，分为两组:阑尾穿孔组和阑尾未穿孔组。回顾性分析术前纤维蛋白原（FIB）、C反应蛋白(CRP)、白细胞计数（WBC）、中性粒细胞比例(NEUT%）水平和术后病理结果。采用受试者工作特征（ROC）曲线评价FIB、CRP、WBC和NEUT%对穿孔性阑尾的诊断效能。结果所有患者的FIB平均水平为（3.98±1.41）g/L。阑尾穿孔组患儿FIB平均水平为（5.35±1.08）g/L，显著高于未穿孔组患儿［(3.17±0.81)g/L］，差异有统计学意义(P<0.001)。FIB最佳临界值为4.23 g/L时，FIB的特异度为82.2%，而WBC为37.2%,CRP为74.4%；敏感度为92.0%，而WBC为80%,CRP为81.3%。FIB在鉴别穿孔和未穿孔阑尾炎ROC曲线下面积大于WBC、CRP和NEUT%。结论术前FIB水平对儿童急性阑尾炎阑尾穿孔具有良好的预测价值。

The predicting value of fibrinogen for acute appendicitis perforation in children

Objective To investigate the diagnostic value of plasma fibrinogen level in predicting acute appendicitis perforation in children. Methods We collected 204 children with acute appendicitis treated by surgery. According to the pathological report results, they were divided into two groups; the perforated appendix group and the non-perforated appendix group. Preoperative fibrinogen (FIB), C-reactive protein (CRP), white blood cell count (WBC), neutrophil ratio (NEUT%) levels and postoperative pathological results were retrospectively analyzed. The diagnostic efficacy of FIB, CRP, WBC, and NEUT% for perforated appendix was evaluated using the receiver operating characteristic curve (ROC). Results The mean FIB level of all patients was (3.98±1.41)g/L. The mean FIB level in the perforated appendix group was (5.35±1.08)g/L, which was significantly higher than that in the non-perforated appendix group (P<0.001). When the optimal critical value of FIB was 4.23 g/L, specificity of FIB for diagnosis of acute appendicitis perforation was 82.2%; while the specificities of WBC and CRP were 37.2% and 74.4%, respectively. The sensitivity of FIB was 92.0%, while with 80% for WBC and 81.3% for CRP. The area under ROC of FIB was greater than those of WBC, CRP and NEUT% in discriminating appendicitis between perforated group and non-perforated group. Conclusion This study shows that preoperative FIB level has a good predictive value for acute appendicitis and appendiceal perforation in children.