Can New Inflammatory Markers Improve the Diagnosis of Acute Appendicitis?
Can New Inflammatory Markers Improve the Diagnosis of Acute Appendicitis?
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DOI：
10.1007/s00268-014-2708-7
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发表时间：
2014-11-01
影响因子：
2.6
通讯作者：
Andersson, Roland E.
中科院分区：
文献类型：
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作者：
Andersson, Manne;Ruber, Marie;Andersson, Roland E.
阑尾炎的诊断困难且耗费资源。新的炎症标志物已被提出用于阑尾炎的诊断，但他们的效用与传统的诊断变量的组合还没有经过测试。我们的目的是探索新的炎症标志物的潜力，以提高阑尾炎的诊断。将21种新炎症标志物（白细胞介素[IL]-6、趋化因子配体[CXCL]-8、趋化因子C-C基序配体[CCL]-2、血清淀粉样蛋白A [SAA]、基质金属蛋白酶[MMP]-9和髓过氧化物酶[MPO]）的诊断特性与阑尾炎炎症反应（AIR）评分中包括的传统诊断变量(右髂孔疼痛、呕吐、反跳压痛、保护、白细胞[WBC]计数、中性粒细胞比例、采用单变量和多变量回归模型对432例疑似阑尾炎患者的c反应蛋白和体温进行分析。在新的炎症变量中，SAA、MPO和MMP9是所有阑尾炎的最强判别因子（受试者工作特征[ROC] 0.71）， SAA是晚期阑尾炎的最强判别因子（ROC 0.80），而防御性或反跳性压痛是所有阑尾炎的最强传统判别因子（ROC 0.84）和晚期阑尾炎的WBC计数（ROC 0.89）。在多变量模型中，CCL2是除AIR评分变量外最强的独立判别因子。AIR评分的ROC面积为0.91，正确分类率为58.3%，准确率为92.9%。这并没有因为加入新的炎症标记物而得到改善。阑尾炎的常规诊断变量，结合AIR评分，是一种有效的筛查工具，用于将阑尾炎患者分为低、不确定或高风险。添加新的炎症变量并没有进一步提高诊断性能。
The diagnosis of appendicitis is difficult and resource consuming. New inflammatory markers have been proposed for the diagnosis of appendicitis, but their utility in combination with traditional diagnostic variables has not been tested. Our objective is to explore the potential of new inflammatory markers for improving the diagnosis of appendicitis.The diagnostic properties of the six most promising out of 21 new inflammatory markers (interleukin [IL]-6, chemokine ligand [CXCL]-8, chemokine C-C motif ligand [CCL]-2, serum amyloid A [SAA], matrix metalloproteinase [MMP]-9, and myeloperoxidase [MPO]) were compared with traditional diagnostic variables included in the Appendicitis Inflammatory Response (AIR) score (right iliac fossa pain, vomiting, rebound tenderness, guarding, white blood cell [WBC] count, proportion neutrophils, C-reactive protein and body temperature) in 432 patients with suspected appendicitis by uni- and multivariable regression models.Of the new inflammatory variables, SAA, MPO, and MMP9 were the strongest discriminators for all appendicitis (receiver operating characteristics [ROC] 0.71) and SAA was the strongest discriminator for advanced appendicitis (ROC 0.80) compared with defence or rebound tenderness, which were the strongest traditional discriminators for all appendicitis (ROC 0.84) and the WBC count for advanced appendicitis (ROC 0.89). CCL2 was the strongest independent discriminator beside the AIR score variables in a multivariable model. The AIR score had an ROC area of 0.91 and could correctly classify 58.3 % of the patients, with an accuracy of 92.9 %. This was not improved by inclusion of the new inflammatory markers.The conventional diagnostic variables for appendicitis, as combined in the AIR score, is an efficient screening instrument for classifying patients as low-, indeterminate-, or high-risk for appendicitis. The addition of the new inflammatory variables did not improve diagnostic performance further.