联合临床和实验室参数对急性阑尾炎诊断的病例对照研究

目的探讨如何优化组合和分析临床和实验室检查数据诊断急性阑尾炎。方法选择2018年7月至2019年6月期间收治的146例急性阑尾炎的患者进行回顾性研究,另选择129例急腹症患者作为对照。记录和分析临床参数:恶心、呕吐、腹泻、排尿困难、局部腹膜炎体征和疼痛转移;实验室参数:C反应蛋白(CRP)、全血计数和尿液检查。结果频繁呕吐、腹泻、排尿困难不是急性阑尾炎的少见表现。单因素logistic回归确定WBC和尿检阴性结果是AA的有统计学意义的预测因子。多元回归分析表明,呕吐(1~2)、腹泻、局部腹膜炎症状阳性、白细胞计数和尿检阴性是AA的显著预测因子。对于单纯性、化脓性以及坏疽性的急性阑尾炎,尿检阴性的预测度下降。结论与急腹症比较,无频繁呕吐、无腹泻、无排尿困难、局限性腹膜炎、WBC升高、尿检阴性是急性阑尾炎诊断和鉴别诊断的重要指标。

Optimized utilization of clinical and laboratory parameters in the diagnosis of acute appendicitis

Objective To analyze the best combination of clinical and laboratory examinations for the diagnosis of acute appendicitis. Methods The data of 146 patients with acute appendicitis admitted to the emergency department of our hospital from July 2018 to June 2019 were collected for a retrospective study, and another 129 patients with acute abdomen as controls. Clinical parameters were recorded and analyzed by logistic regression,including nausea, vomiting, diarrhea, dysuria, signs of local peritonitis and pain migration; laboratory parameters： C-reactive protein （CRP）, complete blood count and urine test. Results Frequent vomiting, no change in appetite, diarrhea, and dysuria were not rare manifestations of acute appendicitis. Univariate logistic regression confirmed that WBC and negative urine test results were statistically significant predictors of acute appendicitis. Multiple regression analysis showed that vomiting （once or twice）, diarrhea, positive symptoms of local peritonitis, white blood cell count and negative urine test were significant predictors of AA. For simple, purulent, and gangrenous acute appendicitis, the predictability of a negative urine test decreases. Conclusion Compared with acute abdomen, no frequent vomiting, no diarrhea, no dysuria, localized peritonitis, elevated WBC, and negative urine test are important indicators for the diagnosis and differential diagnosis of acute appendicitis.