中国循证医学杂志

中国循证医学杂志

中性粒细胞与淋巴细胞比值对儿童复杂性阑尾炎诊断的预测价值

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目的 评价中性粒细胞与淋巴细胞比值(NLR)对儿童复杂性阑尾炎诊断的预测价值。 方法 采用回顾性研究方法,将 2014 年 1 月至 2017 年 6 月就诊于西安交通大学第二附属医院小儿外科符合纳入标准的阑尾炎患者,根据病理结果分为单纯性阑尾炎及复杂性阑尾炎两组。比较两组患者在年龄、性别、发病时间、发热、最高体温、呕吐、右下腹痛、血常规指标及超声结果间的差异,通过单因素及多因素分析筛选可协助诊断儿童复杂性阑尾炎的指标。然后对筛选后的指标绘制受试者工作特征曲线(ROC 曲线),根据约登指数并结合敏感性及特异性评估其在诊断儿童复杂性阑尾炎中的预测价值。 结果 纳入患儿 235 人,其中单纯性阑尾炎 179 人,复杂性阑尾炎 56 人。多因素分析显示中性粒细胞与淋巴细胞计数比值(NLR)是儿童复杂性阑尾炎的独立危险因素。当 NLR>11.74 时,预测复杂性阑尾炎的约登指数最大,为 0.325,敏感性和特异性分别为 47.8% 和 84.7%。与 NLR<11.74 的患儿相比,NLR>11.74 患儿确诊为复杂性阑尾炎的相对危险度为 3.121[95%CI(2.036,4.783)]。 结论 NLR 对儿童复杂性阑尾炎具有较好的预测价值,可为儿童阑尾炎是否选择手术治疗提供参考。

Objectives To assess the predictive value of neutrophils-to-lymphocytes ratio (NLR) in the diagnosis of children complicated appendicitis. Methods The clinical data of patients with acute appendicitis treated in Department of Pediatric Surgery, the Second Affiliated Hospital of Xi’an Jiaotong University from January 2014 to June 2017 were analyzed retrospectively. Based on the pathology results, patients were divided into two groups: simple appendicitis and complicated appendicitis. The differences of age, gender, disease time, fever, highest temperature, emesis, right lower abdominal pain, blood indicators, and ultrasound results between the two groups were analyzed. Useful parameters to aid in the diagnosis of children complicated appendicitis were screened through single-factor and multiple-factor analysis. The predictive value of the parameters was evaluated by ROC analysis, sensitivity and specificity. Results A total of 235 patients was evaluated and divided into simple appendicitis group (179 patients) and complicated appendicitis group (56 patients). Logistic regression analysis revealed that NLR was the independent risk factor for diagnosis of children complicated appendicitis. When NLR>11.74, the Youden index for predictive complicated appendicitis was the biggest, reaching 0.325, and the sensitivity and specificity were 47.8% and 84.7%, respectively (OR=3.121, 95%CI 2.036 to 4.783). Conclusions The preoperative NLR is a certain indicator for predicting children complicated appendicitis, and can be used as reference to whether or not receive an operation.

关键词: 急性阑尾炎; 中性粒细胞与淋巴细胞计数比值; 儿童; 诊断; 手术

Key words: Acute appendicitis; Neutrophil-to-lymphocyte ratio; Children; Diagnosis; Operation

引用本文: 余强, 郭正团, 何英利, 王静. 中性粒细胞与淋巴细胞比值对儿童复杂性阑尾炎诊断的预测价值. 中国循证医学杂志, 2018, 18(10): 1027-1031. doi: 10.7507/1672-2531.201804113 复制

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