[1]段 玮,刘兴晖,李廷俊,等.基于血液炎症相关指标建立儿童复杂性阑尾炎的预测模型及验证[J].现代检验医学杂志,2023,38(02):155-159.[doi:10.3969/j.issn.1671-7414.2023.02.029 ]
　DUAN Wei,LIU Xing-hui,LI Ting-jun,et al.Establishment of Predictive Models and Verification Based on Related Inflammatory Factors in Blood of Complex Appendicitis in Children[J].Journal of Modern Laboratory Medicine,2023,38(02):155-159.[doi:10.3969/j.issn.1671-7414.2023.02.029 ]
点击复制

基于血液炎症相关指标建立儿童复杂性阑尾炎的预测模型及验证()
分享到：

《现代检验医学杂志》[ISSN:/CN:]

卷:
第38卷
期数:
2023年02期
页码:
155-159
栏目:
检验与临床
出版日期:
2023-03-15

文章信息/Info

Title:
Establishment of Predictive Models and Verification Based on Related Inflammatory Factors in Blood of Complex Appendicitis in Children
文章编号:
1671-7414（2023）02-155-05
作者:
段 玮1; 刘兴晖1; 李廷俊2; 黄家虎2; 王扎根2
（1.上海市浦东新区公利医院检验科，上海 200135；2.上海交通大学医学院附属儿童医院急诊科，上海 200062）
Author(s):
DUAN Wei1;  LIU Xing-hui1;  LI Ting-jun2;  HUANG Jia-hu2;  WANG Zha-gen2
（1.Department of Laboratory Medicine, Shanghai Pudong New Area Gongli Hospital, Shanghai 200135, China; 2.Department of Emergency, Children’s Hospital Affiliated to Medical College of Shanghai Jiaotong University, Shanghai 200062, China）
关键词:
复杂性阑尾炎; D-二聚体; C-反应蛋白; 降钙素原; 中性粒细胞淋巴细胞比值; 预测模型
分类号:
R574.61；R446.11
DOI:
10.3969/j.issn.1671-7414.2023.02.029
文献标志码:
A
摘要:
目的 探讨 D-二聚体（DD）、C-反应蛋白（CRP）、降钙素原（PCT）、中性粒细胞与淋巴细胞比值（NLR）及白细胞计数（WBC）等血液中炎症指标对儿童复杂性阑尾炎（complicated acute appendicitis，CAA）的诊断价值，建立预测模型并验证。方法 回顾性分析 2018年 1月～2021年 1月在上海市儿童医院和上海市浦东新区公利医院诊断的 578例阑尾炎患者，根据病理类型分为复杂性阑尾炎组（n=237）和非复杂性阑尾炎组（n=341）。使用二元 Logistic回归分析和卡方自动交互检测（chi-squared automatic interaction detector, CHAID）建立复杂性阑尾炎的预测模型；再通过受试者工作曲线（ROC）对上述两种预测模型进行准确性验证。结果 复杂性阑尾炎组及非复杂性阑尾炎组之间 DD[1.04(0.46, 2.67)mg/L vs 0.36(0.22, 0.58)mg/L]，CRP[51.00(17.00, 98.50)mg/L vs 9.00(5.00. 24.00)mg/L]，PCT[1.06(0.23,2.80)ng/ml vs 0.10(0.05, 2.80)ng/ml]，NLR[9.80(6.56, 15.50) vs 26.93(4.14, 11.60)]及 WBC[16.54(13.48, 20.59)×109/L vs 14.99(12.08, 18.44)×109/L]水平差异有统计学意义（Z=-11.975～-3.799，均 P<0.001）。Logistic回归分析提示 DD， CRP，PCT及 NLR是预测复杂性阑尾炎发生的独立危险因素（P<0.05）。经验证，二元回归预测模型和决策树预测模型的准确率、 AUC值、灵敏度和特异度分别为 80.1%，0.857，79.2%，83.0%；79.6%，0.813，73.8%，86.7%。结论 DD，CRP，PCT及 NLR对小儿复杂性阑尾炎的预判具有较好的临床应用价值；二元回归模型和决策树模型对于儿童复杂性阑尾炎的诊断均有较高的临床应用效能。
Abstract:
Objective To discuss the diagnostic value of D-Dimer (DD), C-reactive protein (CRP), Procalcitonin (PCT), Neutrophil Lymphocyte Ratio (NLR), White Blood Cell (WBC) count to complicated acute appendicitis (CAA) in children, in order to build a prediction model and to verify it. Methods Retrospective analysis of 578 hospitalized children with appendicitis diagnosed were studied in Children’s Hospital of Shanghai and Shanghai Pudong New Area Gongli Hospital from August 2018 to January 2021. They were divided into complex appendicitis group (n = 237) and non-complex appendicitis group (n = 341). The prediction model of complex appendicitis was established using binary Logistic regression analysis and Chi-squared automatic interaction detector（CHAID）, and the accuracy of the above two prediction models were verified by the receiver operating curve (ROC). Results The levels of DD[1.04(0.46, 2.67)mg/L vs 0.36(0.22, 0.58)mg/L], CRP[51.00(17.00, 98.50) mg/L vs 9.00(5.00. 24.00)mg/L], PCT[1.06(0.23, 2.80)ng/ml vs 0.10(0.05, 2.80)ng/ml], NLR[9.80(6.56, 15.50) vs 6.93(4.14, 11.60)] and WBC[16.54(13.48, 20.59)×109/L vs 14.99(12.08, 18.44)×109/L] were higher in complex group than those in non-complex group obviously, the differences were statistically significant(Z=-11.975～-3.799，all P<0.001). Logistic regression analysis showed that DD, CRP, PCT and NLR were independent risk factors for predicting the occurrence of complex appendicitis. Accuracy of Logistic and CHAID were 80.1% and 79.6%. AUC, sensitivity and specificity were 0.857(95%CI:0.826~0.888), 79.2%, 83.0%; 0.813(95%CI：0.776~0.850), 73.8%, 86.7% respectively. Conclusion The detection of DD, CRP, PCT and NLR have good clinical diagnostic values for the prediction of complex appendicitis in children. Both Logistic model and decision tree model have high accuracy, sensitivity and specificity for the diagnosis of complex appendicitis in children.

参考文献/References:

[1] ZACHOS K, FOUZAS S, KOLONITSIOU F, et al. Prediction of complicated appendicitis risk in children [J]. Eur Rev Med Pharmacol Sci, 2021, 25(23):7346-7353.
[2] MORIS D, PAULSON E K, PAPPAS T N. Diagnosis and management of acute appendicitis in adults: A review [J]. JAMA, 2021, 326 (22): 2299-2311.
[3] 雷周满 .白细胞计数、 C反应蛋白、 PCT检测在小儿急性阑尾炎诊断中的应用价值 [J].临床医学 ,2020,40(3):20-22.
LEI Zhouman. Application value of white blood cells count,C-reactive protein and PCT in the diagnosis of acute appendicitis in children [J]. Clinical Medicine,2020,40(3):20-22.
[4] 冯伟 , 赵旭峰 , 崔华雷 .血液学指标在儿童复杂性阑尾炎诊断中的应用进展 [J].山东医药 , 2020, 60(3)： 105-109. FENG Wei, ZHAO Xufeng, CUI Hualei. The application progress of hematological indexes in the diagnosis of complex appendicitis in children [J]. Shandong Medical Journal, 2020, 60 (3): 105-109.
[5] GORTER R R, WASSENAAR E C E, DE BOER O J, et al. Composition of the cellular infiltrate in patients with simple and complex appendicitis [J]. Journal of Surgical Research, 2017, 214: 190-196.
[6] THIELE J R, ZELLER J, BANNASCH H, et al. Targeting C-reactive protein in inflammatory disease by preventing conformational changes[J]. Mediators of Inflammation, 2015, 2015:372432.
[7] FUJII T , TANAKA A , KATAMI H , et al. Applying the pediatric appendicitis score to predict complicated appendicitis in children[J]. Pediatrics International , 2021, 64 (1): e14918.
[8] 袁斌 , 张家德 , 彭建明 , 等 . 血液中 PCT, CRP在儿童急性阑尾炎并发腹膜炎的应用 [J]. 哈尔滨医药 , 2021, 41 (3): 86-87. YUAN Bin, ZHANG Jiade, PENG Jianming, et al. Application of PCT, CRP in acute appendicitis with peritonitis in children [J]. Harbin Medical Journal, 2021, 41 (3): 86-87.
[9] 邱康华 .中性粒细胞 /淋巴细胞比值与肝脏疾病关系的临床研究进展 [J].赣南医学院学报 ,2019,39(1):101-104. QIU Kanghua. Clinical research progress in the relationship between neutrophil-to-lymphocyte ratio and liver diseases [J]. Journal of Gannan Medical University, 2019, 39 (1): 101-104．
[10] 林忠泰 ,魏少明 .中性粒细胞 /淋巴细胞比值在急性复杂性阑尾炎诊断中的临床价值 [J].中外医学研究 ,2020,18(28):73-75. LIN Zhongtai, WEI Shaoming. Clinical value of neutrophil-to-lymphocyte ratio in the diagnosis of complicated acute appendicitis [J]. Chinese and Foreign Medical Research, 2020, 18 (28): 73-75.
[11] HAJIBANDEH S , HAJIBANDEH S , HOBBS N, et al. Neutrophil-to-lymphocyte ratio predicts acute appendicitis and distinguishes between complicated and uncomplicated appendicitis: A systematic review and meta-analysis[J]. American Journal of Surgery, 2020, 219 (1): 154-163.
[12] SEVIN? M M, KINACI E, ?AKAR E, et al. Diagnostic value of basic laboratory parameters for simple and perforated acute appendicitis: An analysis of 3 392 cases [J]. Ulus Travma Acil Cerrahi Derg, 2016, 22(2):155-162.
[13] YAMASHITA H, YUASA N, TAKEUCHI E, et al. Diagnostic value of procalcitonin for acute complicated appendicitis [J]. Nagoya J Med Sci, 2016, 78 (1): 79-88.
[14] 张林 , 张聪 , 李勇 , 等 .白介素 -6、降钙素原及 C-反应蛋白对儿童急性阑尾炎伴穿孔的预测价值研究 [J].临床小儿外科杂志 , 2021, 20(8):749-753. ZHANG Lin, ZHANG Cong, LI Yong, et al. Predictive values of interleukin-6,procalcitonin and C-reactive protein in acute appendicitis with perforation in children [J]. Journal of Clinical Pediatric Surgery, 2021, 20 (8): 749-753.
[15] DESTEK S, GüL V O, MENTE? M ?, et al. Diagnostic efficacy of serum procalcitonin, IL-6, IL-2, and D-dimer levels in an experimental acute appendicitis model [J]. Turk J Gastroenterol, 2019, 30 (7): 641-647.
[16] BU Xiangmao, CHEN Jiahong, WAN Yanzhen, et al. Diagnostic value of D-Dimer combined with WBC count, neutrophil percentage and CRP in differentiating between simple and other severe appendicitis in children[J]. Clinical Laboratory, 2016, 62 (9): 1675-1681.
[17] FENG Wei, ZHAO Xufeng, LI Miaomiao, et al. A clinical prediction model for complicated appendicitis in children younger than five years of age [J]. BMC Pediatr, 2020, 20(1):401.

相似文献/References:

[1]汪建军,余艳丽,任超杰.胶乳增强免疫比浊法两种定量试剂检测D-二聚体的评价[J].现代检验医学杂志,2015,30(05):141.[doi:10.3969/j.issn.1671-7414.2015.05.044]
　WANG Jian-jun,YU Yan-li,REN Chao-jie.Evaluation of Two Kinds of Quantitative Reagents for Detection of D-Dimer by Latex Enhanced Immune Turbidity[J].Journal of Modern Laboratory Medicine,2015,30(02):141.[doi:10.3969/j.issn.1671-7414.2015.05.044]
[2]施瑞洁,刘文康,李博,等.血浆D-D，FDP及血清hs-CRP检测对多发性腔隙性脑梗死的临床意义[J].现代检验医学杂志,2015,30(06):75.[doi:10.3969/j.issn.1671-7414.2015.06.021]
　SHI Rui-jie,LIU Wen-kang,LI Bo,et al.Clinical Study on Plasma D-D，FDP and Sera hs-CRP Test for Multipleh Lacunar Infarction[J].Journal of Modern Laboratory Medicine,2015,30(02):75.[doi:10.3969/j.issn.1671-7414.2015.06.021]
[3]刘 莎,江咏梅,张 鸽,等.两种试剂D-二聚体检测值 与纤维蛋白降解产物值的相关性研究[J].现代检验医学杂志,2015,30(01):108.[doi:10.3969/j.issn.1671-7414.2015.01.030]
　LIU Sha,JIANG Yong-mei,ZHANG Ge,et al.Study of the Correlation of Testing Results by Two Different D-dimer Reagents with Fibrin Degradation Products Result Values[J].Journal of Modern Laboratory Medicine,2015,30(02):108.[doi:10.3969/j.issn.1671-7414.2015.01.030]
[4]张红雨,马兴璇.联合检测D-二聚体和CA153在乳腺癌诊治中的临床意义[J].现代检验医学杂志,2015,30(02):137.[doi:10.3969/j.issn.1671-7414.2015.02.043]
[5]宋文炜.血浆D-二聚体检测对甲状腺癌患者的临床意义[J].现代检验医学杂志,2016,31(06):138.[doi:10.3969/j.issn.1671-7414.2016.06.041]
　SONG Wen-wei.Clinical Significance of Plasma D-dimer Testing in Patients with Thyroid Cancer[J].Journal of Modern Laboratory Medicine,2016,31(02):138.[doi:10.3969/j.issn.1671-7414.2016.06.041]
[6]颜宇飞,邓雪梅,刘明利,等.新型冠状病毒肺炎患者血液NLR，DD和 CRP水平联合检测对死亡风险的评估研究[J].现代检验医学杂志,2021,36(01):92.[doi:10.3969/j.issn.1671-7414.2021.01.023]
　YAN Yu-fei,DENG Xue-mei,LIU Ming-li,et al.Novel Coronavirus Pneumonia Patients’ Blood NLR, DD and CRP Levels Combined Detection for the Evaluation of Death Risk[J].Journal of Modern Laboratory Medicine,2021,36(02):92.[doi:10.3969/j.issn.1671-7414.2021.01.023]
[7]付忠晓,黄　俊,王长征,等.COVID-19患者血浆凝血指标及D-二聚体水平检测对临床分型的鉴别价值[J].现代检验医学杂志,2021,36(02):118.[doi:doi:10.3969/j.issn.1671-7414.2021.02.028]
　FU Zhong-xiao,HUANG Jun,WANG Chang-zheng,et al.Preliminary Study on the Differential Value of Coagulation Indexes and D-dimer Level in the Clinical Classification of COVID-19 Patient[J].Journal of Modern Laboratory Medicine,2021,36(02):118.[doi:doi:10.3969/j.issn.1671-7414.2021.02.028]
[8]谭　雍,严　敏,程　珍,等.433例肺血栓栓塞症患者血液 C-反应蛋白、抗凝血酶和纤维蛋白原及血液学变化特点分析[J].现代检验医学杂志,2022,37(01):203.[doi:10.3969/j.issn.1671-7414.2022.01.042]
　TAN Yong,YAN Min,CHENG Zhen,et al.Analysis of Change Feature of CRP ,Antithrombin, Fibrinogen and Hematological Indexs in 433 Patients with PulmonaryThromboembolism[J].Journal of Modern Laboratory Medicine,2022,37(02):203.[doi:10.3969/j.issn.1671-7414.2022.01.042]

备注/Memo

备注/Memo:
收稿日期：2022-06-21修回日期：2022-12-14
基金项目：浦东新区卫生系统重点学科群建设资助项目（PWZxq2022-08）。
作者简介：段玮（1984-），女，本科，主管技师，主要研究领域为临床基础检验， E-mail：28694997@qq.com。
通讯作者：李廷俊（1980-），男，本科，副主任医师，主要研究领域为小儿急诊医学， E-mail：litj@shchildren.com.cn。

更新日期/Last Update: 2023-03-15