摘要
目的通过分析彩超下急性阑尾炎征象建立预测其严重程度的评分系统,并探究在临床上的应用价值。方法根据急性阑尾炎术后病理结果分为非复杂性阑尾炎组(151例)和复杂性阑尾炎组(92例),通过单因素及多因素logistic回归分析复杂性阑尾炎的独立因素。然后对超声下各征象赋值进行评分,比较两组患者的得分,并绘制受试者工作特征(ROC)曲线,以探讨评分系统诊断复杂性急性阑尾炎的最佳得分值及其灵敏度与特异度。结果复杂性阑尾炎的独立因素有管腔积液、界限不清、腹(盆)腔积液、肠系膜(网膜)增厚及回声增强、肠蠕动异常。急性阑尾炎严重程度评分共17分,非复杂性阑尾炎组评分为3.7(2.0,5.0)分,复杂性阑尾炎组为6.84(5.0,8.7)分,两组比较差异有统计学意义(P<0.05)。曲线下面积AUC为0.824(95%CI:0.768~0.880,P<0.001),最佳诊断截断值为5.5分,即评分≥6分诊断为复杂性阑尾炎,灵敏度为67.4%,特异度为86.8%。结论重视超声下急性阑尾炎征象独立因素有助于复杂性阑尾炎的诊断,新建立的急性阑尾炎严重程度评分系统可指导临床病情评估。
Objective To establish a scoring system for predicting the severity of acute appendicitis by analyzing the signs of acute appendicitis under color ultrasound,and explore its clinical application value.Methods Acute appendicitis was divided into two groups:uncomplicated appendicitis group(151 cases)and complicated appendicitis group(92 cases).The independent factors of complicated appendicitis were analyzed by univariate and multivariate logistic regression.Then,each sign assigned under ultrasound was scored,the scores of the two groups were compared,and the receiver operating characteristic(ROC)curve was drawn to explore the best score value,sensitivity and specificity of the scoring system in diagnosing complex acute appendicitis.Results The independent factors of complex appendicitis were lumen effusion,unclear boundary,abdominal/pelvic effusion,mesentery/omental thickening and echo enhancement,and intestinal peristalsis.The severity score of acute appendicitis was 17 points,that of the non-complicated appendicitis group was 3.7(2.0,5.0),and that of the complicated appendicitis group was 6.84(5.0,8.7),and the difference between the two groups was statistically significant(P<0.05).The AUC under the curve was 0.824(95%CI:0.7688-0.880,P<0.001),the best diagnostic cut-off point was 5.5 points,that is,the score≥6 points was diagnosed as complex appendicitis,the sensitivity was 67.4%,and the specificity was 86.8%.Conclusion Paying attention to the independent factors of ultrasound signs of acute appendicitis is helpful for the diagnosis of complicated appendicitis.The newly established acute appendicitis severity scoring system can guide the clinical evaluation of the disease.
作者
陈秋星
俞欣
甘磊磊
CHEN Qiuxing;YU Xin;GAN Leilei(Department of Emergency,the First Affiliated Hospital of USTC,Hefei,230000,China)
出处
《临床急诊杂志》
CAS
2024年第10期539-543,共5页
Journal of Clinical Emergency
关键词
急性阑尾炎
超声检查
独立因素
评分
acute appendicitis
ultrasound examination
independent factor
scoring system
