目的:本研究的目的是确定与3岁以下儿童急性复杂阑尾炎(CA)相关的危险因素,为急性阑尾炎(AA)的诊治提供理论依据。
方法:对135例小儿AA患者进行回顾性分析,2020年12月至2023年12月期间入住安徽省儿童医院普外科,接受了成功的手术治疗。根据术中和术后病理结果,将患者分为两组:复杂性阑尾炎(CA)(n=97例)和单纯性阑尾炎(UA)(n=38例).临床数据包括性别,年龄,体重,疾病持续时间,术前白细胞计数(WCC),中性粒细胞(NEUT)计数,C反应蛋白(CRP)水平,总胆红素(TBil)水平,降钙素原(PCT)水平,钙卫蛋白(Cal)水平,术前超声检查结果指示存在或不存在粪便,最大阑尾直径,收集并分析小儿阑尾炎疮(PAS)。进行比较分析以调查各组之间的差异并确定CA的危险因素。
结果:CA组在疾病持续时间方面表现出明显更高的值,CRP水平,PCT,Cal,阑尾粪便的存在,最大阑尾直径,而PAS与UA组比拟(P<0.05)。多变量分析确定了CRP水平,最大阑尾直径,和PAS作为CA的独立危险因素。具体来说,CRP水平差异有统计学意义(OR=1.045,95%CI:1.024~1.067,P<0.001),PAS(OR=1.768,95%CI:1.086~2.879,P=0.022),最大阑尾直径(OR=1.860,95%CI:1.085~3.191,P=0.024)差异有统计学意义。PAS的接收器工作特性曲线下面积值为0.6776,CRP为0.7663,和0.5604的最大阑尾直径。
结论:CRP水平,PAS,和最大阑尾直径是3岁以下儿童CA的独立危险因素。这些参数对CA的早期诊断有价值。
OBJECTIVE: The aim of this study is to identify risk factors associated with acute complicated appendicitis (CA) in children aged three years or younger, providing a theoretical foundation for the management and treatment of acute appendicitis (AA).
METHODS: A retrospective analysis was conducted on 135 pediatric patients with AA, admitted to the Department of General Surgery at Anhui Children\'s Hospital between December 2020 and December 2023, who underwent successful surgical treatment. Based on the intraoperative and postoperative pathological findings, patients were categorized into two groups: complicated appendicitis (CA) (n = 97 cases) and uncomplicated appendicitis (UA) (n = 38 cases). Clinical data including gender, age, weight, disease duration, preoperative white blood cell count (WCC), neutrophil granulocyte (NEUT) count, C-reactive protein (CRP) levels, total bilirubin (TBil) levels, procalcitonin (PCT) levels, calprotectin (Cal) levels, preoperative ultrasound results indicating the presence or absence of fecaliths, maximum appendix diameter, and pediatric appendicitis sore (PAS) were collected and analyzed. Comparative analysis was performed to investigate the differences between the groups and identify risk factors of CA.
RESULTS: The CA group exhibited significantly higher values in disease duration, CRP levels, PCT, Cal, presence of appendiceal fecaliths, maximum appendix diameter, and PAS compared to the UA group (P < 0.05). Multivariate analysis identified CRP levels, maximum appendix diameter, and PAS as independent risk factors for CA. Specifically, differences in CRP level (OR = 1.045, 95% CI:1.024 ~ 1.067, P < 0.001), PAS (OR = 1.768, 95% CI:1.086 ~ 2.879, P = 0.022), and maximum appendix diameter (OR = 1.860, 95% CI:1.085 ~ 3.191, P = 0.024) were significant. The area under the receiver operating characteristic curve values were 0.6776 for the PAS, 0.7663 for CRP, and 0.5604 for the maximum appendix diameter.
CONCLUSIONS: CRP levels, PAS, and maximum appendix diameter are independent risk factors for CA in children under three years of age. These parameters are valuable for the early diagnosis of CA.