作为急性阑尾炎诊断和预测标志的中性粒细胞与淋巴细胞比率

Reza Shahkaram, Hamid Reza Shoraka, Maryam Chegeni, Ali Soleimani
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引用次数: 0

摘要

急性阑尾炎是最常见的外科急症之一。中性粒细胞与淋巴细胞比值在诊断阑尾炎中的作用尚存争议。因此,本研究旨在探讨中性粒细胞与淋巴细胞比值对诊断急性阑尾炎的诊断价值。本研究采用病例对照法,调查了 2020 年 7 月至 2021 年 7 月期间在博伊努尔德市(伊朗东北部)接受阑尾炎手术的 505 名患者。纳入标准为年龄在 15-75 岁之间,患者应具有病理诊断结果。排除标准为最近一周内有急性感染、输血史和慢性自身免疫性疾病史。收集参与者手术前的临床病史和症状、实验室检查、超声波检查和 CT 扫描结果。手术后由病理学家对阑尾病理进行评估,病理结果分为已确诊阑尾炎和未确诊阑尾炎两组。收集的变量通过 t 检验或 Mann-Whitney 检验进行分析,并采用逻辑回归法去除可能的混杂因素;诊断准确性采用接收器操作曲线分析法。研究结果显示,273 名(54.3%)参与者为男性,260 名(67.3%)为本市居民。67.3%的患者有恶心和呕吐症状,481人(94.4%)和359人(71.2%)有压痛和疼痛向右移。患者的平均年龄(31.1±12.6)岁。非阑尾炎患者的中性粒细胞与淋巴细胞比值的平均值和标准差为(7.5 ± 6.1),急性阑尾炎患者的中性粒细胞与淋巴细胞比值的平均值和标准差为(3.5 ± 3.3),两组之间存在显著差异(P 值为 0.0001)。在中性粒细胞与淋巴细胞比值的切点为 3.76 时,接收器工作曲线面积为 0.78(95% CI 0.75,0.82),对于该标准,敏感性为 0.74.3(95% CI 69.4,78.7),特异性为 0.74.65(95% CI 66.5,81.7)。在逻辑回归的最终模型中,男性性别的几率比为 1.7(95% CI 1.05,2.65),白细胞计数的几率比为 1.00023(95% CI 1.0005,1.00003),腹痛向右转移的几率比为 1.82(95% CI 1.15,2.98),中性粒细胞与淋巴细胞的几率比为 1.72(95% CI 1.05,2.65),这些都是急性阑尾炎的预测因素。由此可见,中性粒细胞与淋巴细胞比值(NLR)是诊断急性阑尾炎的重要指标。此外,当与男性性别、高白细胞计数和右侧腹痛相结合时,NLR 成为该病症的一组有效预测指标。
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Neutrophil to Lymphocyte Ratio as a Marker in the Diagnosis and Prediction of Acute Appendicitis

Acute appendicitis is one of the most common surgical emergencies. The role of the neutrophils to lymphocytes ratio in diagnosing appendicitis is debatable. For this, this study aimed to investigate the diagnostic value of neutrophils to lymphocytes ratio to diagnose acute appendicitis. In the case–control method designed for this study, a total of 505 candidates for appendicitis surgery from July 2020 to July 2021 in Bojnurd City (eastern north of Iran) were investigated. Inclusion criteria were age 15–75, and the patients should have pathology results for their diagnosis. The exclusion criteria were acute infection in the last week, history of blood transfusion, and history of chronic autoimmune disease. The clinical history and symptoms, laboratory tests, sonography evidence, and CT scans of participants before surgery were gathered. The appendix pathology was evaluated by a pathologist after surgery, and two groups of pathology results were approved appendicitis and no approved appendicitis. Collected variables were analyzed through a t-test or Mann–Whitney test, and logistic regression was used to remove possible confounders; diagnostic accuracy was performed using receiver operating curve analysis. The result of the study showed that 273 (54.3%) of the participants were male and 260 (67.3%) were residents of the city. Sixty-seven point three percent (67.3%) of the patients had nausea and vomiting; the tenderness and shift of pain to the right were reported in 481 (94.4%) and 359 (71.2%) of them, respectively. The mean ± standard deviation age of patients was 31.1 ± 12.6. The mean and standard deviation of neutrophils to lymphocytes ratio in non-appendicitis were 7.5 ± 6.1 and in acute appendicitis were 3.5 ± 3.3, and there was a significant difference between the two groups (p-value < 0.0001). In the cut point of 3.76 for the neutrophil to lymphocyte ratio, the receiver operating curve area was 0.78 (95% CI 0.75, 0.82), and for this criteria, the sensitivity was 0.74.3 (95% CI 69.4, 78.7), and specificity was 0.74.65 (95% CI 66.5, 81.7). In the final model of logistic regression, the odds ratio of male gender was 1.7 (95% CI 1.05, 2.65), leukocyte counts 1.00023 (95% CI 1.0005, 1.00003), abdominal pain shift to the right 1.82 (95% CI 1.15, 2.98), and neutrophils to lymphocytes ratio 1.72 (95% CI 1.05, 2.65), and there were as predictors of acute appendicitis. It is evident that the neutrophil to lymphocyte ratio (NLR) is a valuable marker for diagnosing acute appendicitis. Furthermore, when combined with male gender, high leukocyte count, and right-sided abdominal pain, the NLR becomes an effective set of predictors for this condition.

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