| 摘要: |
| 目的：探讨高频超声回盲部定位法联合血浆纤维蛋白原(Fibrinogen, FIB)测定对儿童的不同病理类型阑尾炎诊断的应用和价值。方法：选择2017年1月到2018年12月在本院收治的阑尾炎患儿62例,经术后病理确诊为阑尾炎者60例为阳性诊断,术中未发现阑尾有炎症或发现其它病变者为阴性诊断。术前应用高频超声回盲部定位法和FIB测定法两种方法联合进行检查,对患儿病情进行全面评价。采用 Kappa 检验分析超声检查对小儿不同病理类型阑尾炎的诊断结果的一致性；分别计算各类型阑尾炎FIB水平和联合诊断对小儿阑尾炎诊断的准确率、敏感度和特异度,并绘制ROC曲线评价联合诊断对小儿阑尾炎的诊断价值。结果：本组62例患者经手术及病理证实60例为急性阑尾炎,径超声诊断60例为急性阑尾炎,超声诊断总体符合率为100%(60/60),但超声检查对各类型阑尾炎诊断与病理诊断相比,诊断一致性一般(Kappa=0.746,P=0.000＜0.001)；阑尾炎患儿FIB随着病理类型逐渐加重,各组组间比较差异具有统计学意义(P<0.05),各组阑尾炎患儿FIB水平均明显高于健康组(P<0.05)；ROC曲线分析显示,FIB诊断单纯性阑尾炎、化脓性阑尾炎、坏疽性阑尾炎的曲线面积(AUC)分别为0.685、0.743、0.785；FIB对单纯性、化脓性、坏疽性阑尾炎的最佳诊断临界值分别为2.37g/L、3.68g/L、4.72g/L,此时敏感度分别为70.87%、72.59%、83.09%、75.09%；联合诊断时,单纯性阑尾炎、化脓性阑尾炎、坏疽性阑尾炎的曲线面积(AUC)分别为0.853、0.872、0.895,敏感度分别为87.50%、90.91%、95.45%,特异度分别为：75.00%、61.22%、73.68%。结论：超声技术的应用对小儿阑尾炎的诊断正确率,但对于不太典型的阑尾炎还缺乏更高的敏感性；利用高频超声回盲部定位法联合血浆纤维蛋白原水平可以进一步提高对小儿各类型阑尾炎的诊断敏感性,有助于进行及时治疗以及治疗方案的合理选择。 |
| 关键词: ROC曲线 超声检查 纤维蛋白原 诊断 阑尾炎 儿童 |
| DOI： |
| 投稿时间：2019-09-03修订日期：2020-09-13 |
| 基金项目: |
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| The value of High Frequency Ultrasound Ileocecal Positioning Method with Plasma Fibrinogen in the Pathological Diagnosis of Appendicitis in Children |
| Ren Qiang,Xu Wei |
| () |
| Abstract: |
| Objective:To explore the application and value of high frequency ultrasound ileocecal localization combined with plasma fibrinogen (FIB) in the diagnosis of appendicitis in children with different pathological types. Methods: Sixty-two children with appendicitis admitted to our hospital from January 2017 to December 2018 were enrolled in this hospital. 60 cases were diagnosed as appendicitis by postoperative pathology. No positive diagnosis was found in the appendix for inflammation or other lesions. . Preoperative high-frequency ultrasound ileocecal positioning method and FIB method were used to conduct a comprehensive examination to evaluate the condition of the child. Kappa test was used to analyze the consistency of ultrasonography in the diagnosis of appendicitis in children with different pathological types. The accuracy, sensitivity and specificity of FIB level and combined diagnosis for appendicitis in children were calculated, and the combined diagnosis of ROC curve was drawn. Diagnostic value of appendicitis in children. Results:In this group of 62 patients, 60 cases were confirmed by surgery and pathology as acute appendicitis. 60 cases of acute appendicitis were diagnosed by ultrasonography. The overall coincidence rate of ultrasound diagnosis was 100% (60/60), but the diagnosis and pathological diagnosis of appendicitis were performed by ultrasonography. In comparison, the diagnostic consistency was generally (Kappa=0.746, P=0.000<0.001); the FIB of children with appendicitis gradually increased with pathological type, and the difference between the groups was statistically significant (P<0.05). The FIB level of children was significantly higher than that of the healthy group (P<0.05). The ROC curve analysis showed that the curve area (AUC) of FIB diagnosis of simple appendicitis, suppurative appendicitis and gangrenous appendicitis was 0.685, 0.743, 0.785, respectively; The optimal diagnostic thresholds for sexual, suppurative, and gangrenous appendicitis were 2.37 g/L, 3.68 g/L, and 4.72 g/L, respectively, and the sensitivity was 70.87%, 72.59%, 83.09%, and 75.09%, respectively; At the time of diagnosis, the curve area (AUC) of simple appendicitis, suppurative appendicitis, and gangrenous appendicitis were 0.853, 0.872, and 0.895, respectively. The sensitivity was 87.50%, 90.91%, and 95.45%, respectively. The specificities were: 75.00%, 61.22. %, 73.68% Conclusion: The application of ultrasound technology is accurate in the diagnosis of appendicitis in children, but it lacks higher sensitivity for less typical appendicitis. The use of high-frequency ultrasound ileocecal localization combined with plasma fibrinogen level can further improve various types of appendicitis in children. The diagnostic sensitivity helps to make timely treatment and a reasonable choice of treatment options. |
| Key words: ROC Curve Ultrasonography Fibrinogen Diagnosis Appendicitis Child |
