改良阿氏评分结合血清C反应蛋白检测对儿童急性阑尾炎的临床应用价值

摘要

目的 探讨改良阿氏评分结合血清C反应蛋白(CRP)检测对儿童急性阑尾炎(acute appendicitis,AAS)的临床应用价值.方法 回顾性分析2015年11月至2016年11月期间我院儿科就诊的78例急性阑尾炎患儿为研究对象,单纯性AAS组32例,化脓性AAS组28例,穿孔性AAS组18例,选取同期体检的正常儿童10例为对照组,采用改良阿氏(Alvarado)评分结合血清CRP检测为受试患儿和正常对照组进行全面评估.结果 手术前单纯性AAS组、化脓性AAS组、穿孔性AAS组CRP参数水平依次上升,且显著高于对照组,组间比较差异有统计学意义(P＜0.05);单纯性AAS组、化脓性AAS组、穿孔性AAS组术后CRP参数均较术前明显下降(P＜0.05),然而依然高于对照组(P＜0.05).与单纯性AAS组、化脓性AAS组比较,穿孔性AAS组患儿手术前Alvarado评分、血清CRP阳性率及二者均阳性的百分比均明显提高(P＜0.05);化脓性AAS组的血清CRP阳性率与二者均阳性率明显高于单纯性AAS组(P＜0.05).结论 血清CRP检测有助于儿童AAS病情诊断、病理分型以及病情程度,改良Alvarado评分联合CRP对诊断AAS具有良好的互补性,能有效提高AAS术前诊断准确性,对临床科学治疗有指导作用,值得临床推广.%Objective Objective to investigate the clinical value of modified CRP score combined with serum C-reactive protein (CRP) test in children with acute appendicitis.Methods Retrospective analysis was conducted with the data from November 2015 to November 2016,using the pediatric clinic of 78 patients with AAS in our hospital as the research object.The simple AAS group has 32 cases while suppurative AAS group has 28 cases.Also,perforation AAS group has 18 cases.10 normal children were selected as control group.We used the modified Alvarado score,then the 78 cases were divided into the high score group and low score group.Also,combined with the CRP detection,the AAS comprehensive assessment was performed.Results Before surgery,in the simple AAS group,AAS group,suppurative and perforative group,the CRP level increased,and significantly higher than the control group(P ＜ 0.05);after surgery,in the simple AAS group,AAS group,suppurative and perforation AAS group,the CRP parameters were significantly decreased (P ＜0.05),but still higher than the control group (P ＜ 0.05).Compared with the simple AAS group and suppurative AAS group,the AAS group with perforated has its Alvarado score before the surgery,and the positive rate of serum CRP and positive percentage were significantly increased (P ＜ 0.05);the positive rate of serum CRP for suppurative AAS group and positive rate were significantly higher than that of group AAS (P ＜ 0.05).Conclusion Detection of serum CRP is helpful for children AAS disease diagnosis,pathological type assessment and severity improvement.The modified Alvarado score combined with CRP have good complementary for the diagnosis of AAS,also can improve the preoperative diagnostic accuracy,so to plays a guiding role in clinical treatment,and is worthy of promotion.