Admission Levels of Serum Amyloid A and Procalcitonin are More Predictive of the Diagnosis of Acute Appendicitis Compared With C-reactive Protein
Admission Levels of Serum Amyloid A and Procalcitonin are More Predictive of the Diagnosis of Acute Appendicitis Compared With C-reactive Protein
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DOI：
10.1097/sle.0000000000000067
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发表时间：
2014-12-01
影响因子：
1
通讯作者：
Ammori, Basil J.
中科院分区：
文献类型：
--
作者：
Abbas, Muhammad H.;Choudhry, Muhammad N.;Ammori, Basil J.
背景：急性阑尾炎是最常见的外科急症，但其诊断难以捉摸，阑尾切除术阴性率为20%。本研究的目的是探讨急性炎症标志物血清淀粉样蛋白A （SAA）和血清降钙素原（ProCT）在成人急性阑尾炎诊断中的潜在价值，并与常用的血清c反应蛋白（CRP）进行比较。方法：以急性右下腹痛和临床怀疑为急性阑尾炎的成年患者为研究对象。入院6小时内采集血样，用于快速血清CRP测定和招募结束时SAA和血清ProCT浓度的批量分析。结果：共纳入147例患者（男性81例），平均（+/- SD）年龄36（+/- 17）岁。行阑尾切除术的72例患者中有61例（84.7%）经组织学证实为阑尾炎。事后分析显示SAA的诊断敏感性和特异性分别为92%和72%，ProCT为85%和74%，CRP为75%和72%。曲线下面积的受试者操作者特征显示，SAA （P = 0.011）和ProCT （P = 0.037）在预测入院时急性阑尾炎方面明显优于CRP。结论：在临床疑似急性阑尾炎患者入院时测定SAA和血清ProCT在辅助诊断方面似乎优于血清CRP。
Background: Acute appendicitis is the commonest surgical emergency, but its diagnosis can be elusive with a negative appendicectomy rate of 20%. The aims of this study were to investigate the potential value of the markers of acute inflammation, serum amyloid A (SAA), and serum procalcitonin (ProCT), in the diagnosis of acute appendicitis in adults and to compare that with the commonly used serum C-reactive protein (CRP).Methods: Adult patients presenting with acute right lower abdominal pain and a clinical suspicion of acute appendicitis were included. Blood samples were obtained within 6 hours of admission for rapid serum CRP assay and for end-of-recruitment batch analysis of SAA and serum ProCT concentrations.Results: A total of 147 patients (81 males) with a mean (+/- SD) age of 36 (+/- 17) years were recruited. Appendicitis was confirmed histologically in 61 of 72 patients (84.7%) who underwent appendicectomy. A post hoc analysis revealed a diagnostic sensitivity and specificity for SAA of 92% and 72%, ProCT of 85% and 74%, and CRP of 75% and 72%, respectively. The receiver operator characteristics for the area under the curves showed that SAA (P = 0.011) and ProCT (P = 0.037) significantly exceeded CRP in the prediction of acute appendicitis on admission.Conclusions: The measurement of SAA and serum ProCT on admission in patients with clinically suspected acute appendicitis seems to outperform serum CRP in aiding that diagnosis.