2022 年第 8 期 第 17 卷

四种评分系统对儿童急性阑尾炎的诊断价值

Diagnostic value of four scoring systems for acute appendicitis in children

作者：陈玲玲黄栋刘蕊蕊潘飞飞石娟

英文作者：Chen Lingling Huang Dong Liu Ruirui Pan Feifei Shi Juan

单位：贵州医科大学附属人民医院儿童重症医学科，贵阳550000

英文单位：Pediatric Intensive Care Unit Affiliated People′s Hospital of Guizhou Medical University Guiyang 550000 China

关键词：阑尾炎；Tzanakis评分；改良Alvarado评分；阑尾炎炎症反应评分；儿童阑尾炎评分

英文关键词：Appendicitis;Tzanakisscore;ModifiedAlvaradoscore;Appendicitisinflammatoryresponsescore;Pediatricappendicitisscore

• 摘要：

• 目的 分析Tzanakis评分、改良Alvarado评分、阑尾炎炎症反应（AIR）评分及儿童阑尾炎评分（PAS）对儿童急性阑尾炎（AA）的诊断价值。方法 回顾性分析2020年1月至2021年4月于贵州医科大学附属人民医院行手术治疗的161例疑似AA患儿的资料，以病理诊断结果作为诊断“金标准”，据病理诊断结果分为单纯性AA（A组，本研究视为阴性阑尾切除病例）和复杂性AA（B组，包括化脓性、坏疽性和/或穿孔性AA，本研究视为阳性阑尾切除病例）。绘制受试者工作特征（ROC）曲线，比较不同评分系统对儿童AA的诊断效能。计算改良Alvarado评分、AIR评分、PAS联合腹部超声诊断的敏感度、特异度和准确度。结果 阑尾切除标本病理诊断结果显示，A组30例（18.6%），B组131例（81.4%）。腹部超声诊断的特异性为70.0%、准确度为74.5%。B组4种评分系统的高危患儿比例均高于A组，低危患儿比例均低于A组，差异均有统计学意义（均P＜0.001）。ROC曲线分析结果显示，Tzanakis评分、改良Alvarado评分、AIR评分及PAS诊断复杂性AA的曲线下面积分别为0.849、0.819、0.746及0.845。当Tzanakis评分≥11分、改良Alvarado评分≥7分、AIR评分≥8分、PAS≥7分时，可考虑诊断为儿童复杂性AA。Tzanakis评分、改良Alvarado评分及PAS的敏感度和准确度均高于AIR评分，差异有统计学意义（均P＜0.05）。改良Alvarado评分、AIR评分、PAS三者各自联合腹部超声诊断的敏感度和准确度均高于三者单独使用，且均高于Tzanakis评分（均P＜0.05）。 结论 4种评分系统对儿童AA均具有一定的临床诊断价值。单独应用时，Tzanakis评分、改良Alvarado评分和PAS的诊断效能较高。改良Alvarado评分、AIR评分及PAS联合腹部超声诊断的敏感度和准确度更佳。

• Objective To analyze the diagnostic value of Tzanakis score, modified Alvarado score, appendicitis inflammatory response (AIR) score and pediatric appendicitis score (PAS) in children with acute appendicitis (AA). Methods A retrospective analysis was performed on 161 cases of children with suspected AA who underwent surgical treatment in Affiliated People′s Hospital of Guizhou Medical University from January 2020 to April 2021. According to the "gold standard" by pathological results, the children were divided into simple AA（group A, they were considered as negative appendectomy cases）and complex AA (group B, including suppurative, gangrene and/or perforated AA, they were considered as positive appendectomy cases). The diagnostic efficacies of different scoring systems for AA in children were compared by receiver operating characteristic (ROC) curve. The sensitivity, specificity and accuracy of modified Alvarado score, AIR score and PAS combined with abdominal ultrasound were calculated. Results The pathological diagnosis of appendevtomy specimens showed that there were 30 cases (18.6%) in group A, and 131 cases (81.4%) in group B. The specificity and accuracy of abdominal ultrasound diagnosis were 70.0% and 74.5%. The rates of high-risk children in the 4 scoring systems in group B were higher than those in group A, and the rates of low-risk children were lower than those in group A (all P<0.001). ROC curve analysis showed that the areas under curve of Tzanakis score, modified Alvarado score, AIR score and PAS were 0.849, 0.819, 0.746 and 0.845, respectively. When Tzanakis score ≥11, modified Alvarado score ≥7, AIR score ≥8 and PAS ≥7, children with complex AA was considered for diagnosis. The sensitivity and accuracy of Tzanakis score, modified Alvarado score and PAS were higher than those of AIR score (all P<0.05). When modified Alvarado score, AIR score and PAS were respectively combined with abdominal ultrasound for diagnosis, the sensitivity and accuracy of the three scoring systems were higher than those without ultrasound, respectively, and were higher than those of Tzanakis score (all P<0.05). Conclusions  All the 4 scoring systems have certain clinical diagnostic value for children with AA, and Tzanakis score, modified Alvarado score and PAS have higher diagnostic efficacy when use alone. The modified Alvarado score, AIR score and PAS have better sensitivity and accuracy when they are combined with abdominal ultrasound.