改良Alvarado评分系统、C-反应蛋白联合uPAR可用于诊断儿童急性阑尾炎

孙传玮; 李爱军; 孙红; 张玮; 王贵波; 雷杰; 杨忠刚

doi:10.16016/j.1000-5404.202005235

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改良Alvarado评分系统、C-反应蛋白联合uPAR可用于诊断儿童急性阑尾炎

儿科临床研究 | 更新时间：2026-01-09

- 改良Alvarado评分系统、C-反应蛋白联合uPAR可用于诊断儿童急性阑尾炎
- Urokinase-type plasminogen activator receptor combined with modified Alvarado scoring system and C-reactive protein for diagnosis of acute appendicitis in children
- 第三军医大学学报 2020年42卷第22期页码：2176-2181
- 作者机构：
  
  075000 河北张家口, 河北北方学院附属第一医院儿外科
- 作者简介：
  
  [ 孙传玮，E-mail: chuanweisun@163.com SUN Chuanwei, E-mail: chuanweisun@163.com
- 基金信息：
  
  张家口市科技攻关计划项目(1421144D)
- DOI：10.16016/j.1000-5404.202005235
  中图分类号： R446.11;R726.568
- 收稿：2020-05-26，
  
  修回：2020-09-15，
  
  纸质出版：2020-11-30
- 稿件说明：
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孙传玮, 李爱军, 孙红, 等. 改良Alvarado评分系统、C-反应蛋白联合uPAR可用于诊断儿童急性阑尾炎[J]. 第三军医大学学报, 2020,42(22):2176-2181.

Chuanwei SUN, Aijun LI, Hong SUN, et al. Urokinase-type plasminogen activator receptor combined with modified Alvarado scoring system and C-reactive protein for diagnosis of acute appendicitis in children[J]. Journal of Third Military Medical University, 2020, 42(22): 2176-2181.
孙传玮, 李爱军, 孙红, 等. 改良Alvarado评分系统、C-反应蛋白联合uPAR可用于诊断儿童急性阑尾炎[J]. 第三军医大学学报, 2020,42(22):2176-2181. DOI： 10.16016/j.1000-5404.202005235.

Chuanwei SUN, Aijun LI, Hong SUN, et al. Urokinase-type plasminogen activator receptor combined with modified Alvarado scoring system and C-reactive protein for diagnosis of acute appendicitis in children[J]. Journal of Third Military Medical University, 2020, 42(22): 2176-2181. DOI： 10.16016/j.1000-5404.202005235.

摘要

目的

探讨急性阑尾炎患儿血清中尿激酶型纤溶酶原激活物受体(urokinase-type plasminogen activator receptor

uPAR)的水平，并评价其联合C反应蛋白(C-reactive protein

CRP)、改良Alvarado评分的诊断价值。

方法

对我院2017年6月至2019年6月期间57例经病理诊断的急性阑尾炎患儿和44例非阑尾炎腹痛患儿进行研究。分析两组患儿年龄、性别、白细胞(white blood cell

WBC)、中性粒细胞与淋巴细胞比率(neutrophil to lymphocyte ratio

NLR)、CRP水平、中性粒细胞百分数、改良Alvarado评分及uPAR水平差异。评估血清uPAR与CRP、改良Alvarado评分的相关性并采用ROC曲线探索上述指标单独或联合对急性阑尾炎的诊断效能。根据净重新分类指数(net reclassification index，NRI)和整体鉴别指数(integrated discrimination index，IDI)评价各联合模型对疾病的诊断价值。

结果

在急性阑尾炎患儿中，WBC、NLR、改良Alvarado评分、CRP及uPAR水平高于对照组患儿。uPAR水平与改良Alvarado评分、CRP具有良好正相关关系。CRP+改良Alvarado评分、uPAR+CRP+改良Alvarado评分的ROC曲线下面积(area under curve

AUC)分别为0.819(0.730~0.888)、0.823(0.734~0.891)，其对应的NRI、IDI分别增加0.653(0.316~0.990)、0.086(0.036~0.136)。

结论

uPAR与改良Alvarado评分、CRP联合检测可作为儿童急性阑尾炎的一个有效诊断指标。

Abstract

Objective

To investigate the serum level of urokinase-type plasminogen activator receptor (uPAR) in children with acute appendicitis and assess the diagnostic value of uPAR combined with C-reactive protein (CRP) and modified Alvarado score for acute appendicitis.

Methods

We analyzed the clinical data of 57 children with pathologically confirmed acute appendicitis and 44 children with nonappendicitis abdominal pain (control group) admitted in our hospital between June 2017 and June 2019. We compared the age

gender

white blood cell count

neutrophil/lymphocyte ratio (NLR)

CRP level

percentage of neutrophils

modified Alvarado score and serum uPAR level between the 2 groups. The correlation of serum uPAR level with CRP and modified Alvarado score was evaluated

and receiving-operator characteristic (ROC) curve was used to analyze their diagnostic efficacy

either alone or in combination

for acute appendicitis. The diagnostic value of each combined model was evaluated according to net reclassification improvement (NRI) and integrated discrimination index (IDI).

Results

White blood cell count

NLR

modified Alvarado score

CRP and uPAR levels were significantly higher in children with acute appendicitis than those in the control group. Serum uPAR level showed significantly positive correlations with modified Alvarado score and CRP level. The areas under the ROC curve of CRP combined with modified Alvarado score and uPAR combined with both CRP and modified Alvarado score were 0.819 (0.730~0.888) and 0.823 (0.734~0.891)

respectively; the NRI and IDI of uPAR combined with CRP and modified Alvarado score was 0.653 (0.316~0.990) and 0.086 (0.036~0.136)

respectively.

Conclusion

Serum uPAR level combined with modified Alvarado score and CRP can be used as an effective diagnostic indicator for acute appendicitis in children.

关键词

Keywords

references

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