目的:本研究旨在探讨血清全身炎症指标包括中性粒细胞-淋巴细胞比值(NLR)的预测能力,血小板-淋巴细胞比率(PLR),单核细胞-嗜酸性粒细胞比率(MER),和C反应蛋白(CRP)水平用于区分急诊(ED)住院的成年患者中无并发症和复杂的急性阑尾炎。
方法:本回顾性研究,横截面,观察,单中心研究纳入了在2019年1月1日至2021年12月31日期间入住我们三级护理大学医院ED的212例连续的急性阑尾炎成年患者.患者分为两组(I组,单纯性急性阑尾炎;第二组,复杂性阑尾炎)根据其手术发现和组织病理学检查。在患者之间比较入院时测量的全身炎症标志物,以确定与并发急性阑尾炎相关的因素。
结果:共132名患者,男性83人(62.9%),女性49人(37.1%),包括在研究中。平均年龄为34.7±13.40岁。根据组织病理学检查,I组患者数量为103例(78.03%),II组为29例(21.96%).入院时的实验室检查结果显示,就平均血清NLR而言,I组和II组患者之间没有显着差异。MER,和CRP值(分别为p=0.096,p=0.248和p=0.297)。然而,II组患者的平均血清PLR在统计学上显著高于I组(p=0.032).平均血清单核细胞和单核细胞分数(%)值显着降低,与第I组患者相比,第II组患者的平均血清中性粒细胞分数(%)值较高。接受操作员特征(ROC)分析发现,用于区分成人患者中单纯性和复杂性急性阑尾炎的血清PLR临界值≥133.73,具有60%的敏感性和58.4%的特异性。此外,ROC分析显示,单核细胞的截止分数(%)水平≤6,灵敏度为72%,特异性为64%,用于区分成人患者中简单和复杂的急性阑尾炎。
结论:我们的研究结果表明,平均血清NLR,MER,成人急性阑尾炎患者入院时测得的CRP值不能预测复杂的急性阑尾炎。然而,平均血清PLR和中性粒细胞和单核细胞计数可用于区分复杂病例。
OBJECTIVE: This study aimed to investigate the predictive power of serum systemic inflammatory markers including neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-eosinophil ratio (MER), and C-reactive protein (CRP) levels for distinguishing uncomplicated and complicated acute appendicitis in adult patients admitted to the emergency department (ED).
METHODS: This retrospective, cross-sectional, observational, and single-center study enrolled 212 consecutive adult patients with acute appendicitis who were admitted to the ED of our tertiary care university hospital between January 1, 2019 and December 31 2021. Patients were divided into two groups (Group I, uncomplicated acute appendicitis; Group II, complicated appendicitis) according to their surgical findings and histopathological examination. Systemic inflammatory markers measured on admission were compared among patients to identify factors associated with complicated acute appendicitis.
RESULTS: A total of 132 patients, 83 male (62.9%) and 49 female (37.1%), were included in the study. The mean age was 34.7±13.40 years. Based on the histopathological examination, the number of patients in Group I was 103 (78.03%) and 29 (21.96%) in Group II. Laboratory findings on admission revealed no significant differences between Groups I and II patients in terms of mean serum NLR, MER, and CRP values (p=0.096, p=0.248, and p=0.297, respectively). However, the mean serum PLR in Group II patients was statistically significantly higher than those in Group I (p=0.032). The mean serum monocyte and monocyte fraction (%) values were significantly lower, and the mean serum neutrophil fraction (%) value was higher in Group II patients compared to those with Group I. Receiving operator characteristic (ROC) analysis identified a serum PLR cutoff value of ≥133.73 for distinguishing uncomplicated and complicated acute appendicitis in adult patients, with 60% sensitivity and 58.4% specificity. In addition, ROC analysis revealed a cutoff monocyte fraction (%) level of ≤6, with 72% sensitivity and 64% specificity, for distinguishing uncomplicated and complicated acute appendicitis in adult patients.
CONCLUSIONS: Our findings indicate that the mean serum NLR, MER, and CRP values measured on admission to ED in adult patients with acute appendicitis could not predict complicated acute appendicitis. However, mean serum PLR and neutrophil and monocyte counts can be useful in distinguishing complicated cases.