CAJ | 학술논문

目的探讨外周血中性粒细胞 CD64指数对于早期诊断儿童急性阑尾炎的临床应用价值。方法选择2011年12月至2013年12月于青岛市妇女儿童医院就诊，经查体和辅助影像学检查诊断为疑似急性阑尾炎的90例患儿为研究对象。对其采取外周血中性粒细胞 CD64指数检测和血培养2种方法进行确诊，并将经血培养诊断确诊为急性阑尾炎的患儿纳入急性阑尾炎组。采用统计学分析方法对外周血中性粒细胞CD64指数检测诊断儿童急性阑尾炎的结果与血培养结果进行比较，并分析外周血中性粒细胞CD64指数对诊断该病的灵敏度和特异度、阳性预测值和阴性预测值。将同期于同一家医院体检的50例健康儿童纳入对照组，按照相同方法测定其外周血中性粒细胞CD64指数，并测定急性阑尾炎组与对照组受试者血常规、C反应蛋白(CRP)水平。对两组受试者的外周血中性粒细胞 CD64指数、CRP 水平及白细胞(WBC)计数进行统计学分析。本研究遵循的程序符合青岛市妇女儿童医院人体试验委员会制定的伦理学标准，得到该委员会批准，分组征得受试对象监护人的知情同意，并与其签署临床研究知情同意书。结果本组疑似急性阑尾炎的90例患儿中，经血培养诊断确诊为急性阑尾炎的患儿为44例，纳入急性阑尾炎组。急性阑尾炎组与对照组患儿的年龄、性别等基线资料比较，差异无统计学意义(P>0.05)。外周血中性粒细胞CD64指数诊断急性阑尾炎的灵敏度为97.73%(43/44)，特异度为95.65%(44/46)，阳性预测值和阴性预测值分别为95.56%(43/45)和97.78%(44/45)，诊断符合率为96.67%(88/90)。外周血中性粒细胞CD64指数对急性阑尾炎的诊断结果与血培养结果比较，差异无统计学意义(P>0.05)。急性阑尾炎组中性粒细胞CD64、CRP水平及 WBC水平计数均显著高于对照组，且差异有统计学意义(P<0.001)。结论外周血中性粒细胞CD64指数检测可有效诊断儿童急性阑尾炎，并具有检测方法简单易行及诊断迅速等优点，可作为急性阑尾炎早期临床筛查手段。虽然该法诊断儿童急性阑尾炎的灵敏度和特异度均较血培养略低，但二者各有利弊，临床医师可根据实际需求合理选择诊断方法。目的探討外週血中性粒細胞 CD64指數對于早期診斷兒童急性闌尾炎的臨床應用價值。方法選擇2011年12月至2013年12月于青島市婦女兒童醫院就診，經查體和輔助影像學檢查診斷為疑似急性闌尾炎的90例患兒為研究對象。對其採取外週血中性粒細胞 CD64指數檢測和血培養2種方法進行確診，併將經血培養診斷確診為急性闌尾炎的患兒納入急性闌尾炎組。採用統計學分析方法對外週血中性粒細胞CD64指數檢測診斷兒童急性闌尾炎的結果與血培養結果進行比較，併分析外週血中性粒細胞CD64指數對診斷該病的靈敏度和特異度、暘性預測值和陰性預測值。將同期于同一傢醫院體檢的50例健康兒童納入對照組，按照相同方法測定其外週血中性粒細胞CD64指數，併測定急性闌尾炎組與對照組受試者血常規、C反應蛋白(CRP)水平。對兩組受試者的外週血中性粒細胞 CD64指數、CRP 水平及白細胞(WBC)計數進行統計學分析。本研究遵循的程序符閤青島市婦女兒童醫院人體試驗委員會製定的倫理學標準，得到該委員會批準，分組徵得受試對象鑑護人的知情同意，併與其籤署臨床研究知情同意書。結果本組疑似急性闌尾炎的90例患兒中，經血培養診斷確診為急性闌尾炎的患兒為44例，納入急性闌尾炎組。急性闌尾炎組與對照組患兒的年齡、性彆等基線資料比較，差異無統計學意義(P>0.05)。外週血中性粒細胞CD64指數診斷急性闌尾炎的靈敏度為97.73%(43/44)，特異度為95.65%(44/46)，暘性預測值和陰性預測值分彆為95.56%(43/45)和97.78%(44/45)，診斷符閤率為96.67%(88/90)。外週血中性粒細胞CD64指數對急性闌尾炎的診斷結果與血培養結果比較，差異無統計學意義(P>0.05)。急性闌尾炎組中性粒細胞CD64、CRP水平及 WBC水平計數均顯著高于對照組，且差異有統計學意義(P<0.001)。結論外週血中性粒細胞CD64指數檢測可有效診斷兒童急性闌尾炎，併具有檢測方法簡單易行及診斷迅速等優點，可作為急性闌尾炎早期臨床篩查手段。雖然該法診斷兒童急性闌尾炎的靈敏度和特異度均較血培養略低，但二者各有利弊，臨床醫師可根據實際需求閤理選擇診斷方法。
목적탐토외주혈중성립세포 CD64지수대우조기진단인동급성란미염적림상응용개치。방법선택2011년12월지2013년12월우청도시부녀인동의원취진，경사체화보조영상학검사진단위의사급성란미염적90례환인위연구대상。대기채취외주혈중성립세포 CD64지수검측화혈배양2충방법진행학진，병장경혈배양진단학진위급성란미염적환인납입급성란미염조。채용통계학분석방법대외주혈중성립세포CD64지수검측진단인동급성란미염적결과여혈배양결과진행비교，병분석외주혈중성립세포CD64지수대진단해병적령민도화특이도、양성예측치화음성예측치。장동기우동일가의원체검적50례건강인동납입대조조，안조상동방법측정기외주혈중성립세포CD64지수，병측정급성란미염조여대조조수시자혈상규、C반응단백(CRP)수평。대량조수시자적외주혈중성립세포 CD64지수、CRP 수평급백세포(WBC)계수진행통계학분석。본연구준순적정서부합청도시부녀인동의원인체시험위원회제정적윤리학표준，득도해위원회비준，분조정득수시대상감호인적지정동의，병여기첨서림상연구지정동의서。결과본조의사급성란미염적90례환인중，경혈배양진단학진위급성란미염적환인위44례，납입급성란미염조。급성란미염조여대조조환인적년령、성별등기선자료비교，차이무통계학의의(P>0.05)。외주혈중성립세포CD64지수진단급성란미염적령민도위97.73%(43/44)，특이도위95.65%(44/46)，양성예측치화음성예측치분별위95.56%(43/45)화97.78%(44/45)，진단부합솔위96.67%(88/90)。외주혈중성립세포CD64지수대급성란미염적진단결과여혈배양결과비교，차이무통계학의의(P>0.05)。급성란미염조중성립세포CD64、CRP수평급 WBC수평계수균현저고우대조조，차차이유통계학의의(P<0.001)。결론외주혈중성립세포CD64지수검측가유효진단인동급성란미염，병구유검측방법간단역행급진단신속등우점，가작위급성란미염조기림상사사수단。수연해법진단인동급성란미염적령민도화특이도균교혈배양략저，단이자각유리폐，림상의사가근거실제수구합리선택진단방법。
Objective To explore the clinical value of neutrophil CD64 index in the early diagnosis of acute appendicitis in children.Methods From December 2011 to December 2013,a total of 90 children with suspected acute appendicitis in Hospital for Women and Children of Qingdao were enrolled into this study. Neutrophil CD64 index and blood culture detections were used to diagnose acute appendicitis.And those who were diagnosed as acute appendicitis definitely by blood cultures were included into acute appendicitis group. Compare the diagnosis results of neutrophil CD64 index and blood culture detections by statistical methods. Analyze the sensitivity and specificity of neutrophil CD64 index detection.50 cases of children with normal physical examination in our hospital during the same period were included into control group.They also received neutrophil CD64 index detection as the acute appendicitis group and both the two groups received blood routine examination.Compare the neutrophil CD64 index,C-reactive protein (CRP)and white blood cell (WBC)counts between the two groups.The study protocol was approved by the Ethical Review Board of Investigation of Hospital for Women and Children of Qingdao.Informed consent was obtained from all participants′parents.Results Among the 90 children with suspected acute appendicitis,there were 44 cases who were diagnosed as acute appendicitis definitely by blood cultures,and were included into acute appendicitis group.There were no significance differences between acute appendicitis group and control group in gender,age etc.baseline data (P>0.05).The sensitivity of neutrophil CD64 index detection was 97.73% (43/44),the specificity was 95.65% (44/46).The positive predictive value and negative predictive value were 95.56% (43/45),and 97.78% (44/45),respectively.There was no significant difference between the diagnosis results of neutrophil CD64 index and blood culture detections (P>0.05). The neutrophil CD64 index,levels of CRP and WBC counts in acute appendicitis group were significantly higher than those in control group (P<0.05).Conclusions Neutrophil CD64 index detection can be used as an effective method to diagnose and early clinical screen acute appendicitis in children for its advantages of simple and rapid diagnosis.Though the sensitivity and specificity of neutrophil CD64 index detection are slightly lower than those of blood culture detection,they both have their advantages and disadvantages, clinicians should make a reasonable choice between the two methods according to the actual situation.