Abstract:

Objective　To explore the value of C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-13 (IL-13), and immunoglobulin E (IgE) in the diagnosis of complicated acute appendicitis in children. Methods　One hundred and fifty-four children with acute appendicitis treated at Shaanxi Forest Industry Workers' Hospital from February 2022 to February 2024 were selected as the study objects, including 90 males and 64 females. They were (6.73±3.18) years old. According to the pathological classification, they were divided into a simple acute appendicitis group (103 cases) and a complicated acute appendicitis group (51 cases). The clinical data and levels of CRP, IL-6, IL-13, and IgE in peripheral blood were compared between the two groups. The indicators of statistical significance were included into the multivariate logistic regression analysis. The receiver operating characteristic curve (ROC) was drawn to analyze the efficacy of the screening indicators in the diagnosis of complicated acute appendicitis in the children. Results　There were statistical differences in gender and vomiting between the two groups (both P0.05). The age and level of IgE in the complicated acute appendicitis group were lower than those in the simple acute appendicitis group [(5.69±2.85) years vs. (7.27±2.91) years and (76.06±52.34) μg/L vs. (161.64±58.10) μg/L]; the onset time in the complicated acute appendicitis group was shorter than that in the simple acute appendicitis group [(27.04±9.61)h vs. (20.13±6.73)h]; the levels of CRP, IL-6, and IL-13 and the proportion of the children with fever before the surgery in in the complicated acute appendicitis group were higher than those in the simple acute appendicitis group [(78.41±30.19) mg/L vs. (28.31±11.32) mg/L, (16.85±5.26) ng/L vs. (7.88±3.22) ng/L, (19.80±7.70) ng/L vs. (8.00±3.36) ng/L, and 74.51% (38/51) vs. 45.63% (47/103)]; there were statistical differences (t=3.913, 8.883, 5.177, 14.897, 13.073, and 13.244; χ²=11.503; all P0.05). The results of multivariate logistic regression analysis showed that CRP [OR=6.221 (95%CI 1.950-19.852)], IL-6 [OR=18.394 (95%CI 3.972-85.176)], and IL-13 [OR=10.186 (95%CI 4.507-23.020)] were independent risk factors for complicated acute appendicitis, and IgE [OR=0.162 (95%CI 0.062-0.424)] was an independent protective factor (all P0.05). The ROC results showed that the area under the curve (AUC) of the combined model was 0.924 (95%CI 0.881-0.966), and the optimal threshold was  76.84; the AUC of IgE was 0.915 (95%CI 0.867-0.962), and the optimal threshold was  106.0 μg/L. Conclusion　Serum CRP, IL-6, IL-13, and IgE alone and their combination can be used for the differential diagnosis of complicated acute appendicitis in children. Among them, IgE and the combined model have the best effects.

Key words:

Acute appendicitis, Children, Type I hypersensitivity specific markers, C-reactive protein, Interleukin-6, Diagnosis

摘要：

目的　探讨血清C反应蛋白（CRP）、白细胞介素-6（IL-6）、白细胞介素-13（IL-13）、免疫球蛋白E（IgE）在儿童复杂性急性阑尾炎中的诊断价值。方法　回顾性分析，选取2022年2月至2024年2月在陕西省森林工业职工医院治疗的154例急性阑尾炎患儿作为研究对象，其中男90例、女64例，年龄（6.73±3.18）岁。根据病理分型分为单纯性急性阑尾炎组（103例）和复杂性急性阑尾炎组（51例）。对比两组患儿临床资料及外周血中CRP、IL-6、IL-13、IgE水平，并对组间有差异指标进行多因素logistic回归分析，采用受试者操作特征曲线（ROC）分析筛选指标对儿童复杂性急性阑尾炎的诊断效能。统计学方法采用t检验、χ²检验。结果　两组患儿性别、呕吐比较，差异均无统计学意义（均P0.05）；复杂性急性阑尾炎患儿年龄、IgE水平均低于单纯性急性阑尾炎患儿［（5.69±2.85）岁比（7.27±2.91）岁、（76.06±52.34）μg/L比（161.64±58.10）μg/L］，发病时间长于单纯性急性阑尾炎患儿［（27.04±9.61）h比（20.13±6.73）h］，CRP、IL-6、IL-13水平及术前发热比例均高于单纯性急性阑尾炎患儿［（78.41±30.19）mg/L比（28.31±11.32）mg/L、（16.85±5.26）ng/L比（7.88±3.22）ng/L、（19.80±7.70）ng/L比（8.00±3.36）ng/L、74.51%（38/51）比45.63%（47/103）］，差异均有统计学意义（t=3.913、8.883、5.177、14.897、13.073、13.244，χ²=11.503；均P0.05）。多因素logistic回归分析结果显示，CRP［OR=6.221（95%CI 1.950～19.852）］、IL-6［OR=18.394（95%CI 3.972～85.176）］、IL-13［OR=10.186（95%CI 4.507～23.020）］是复杂性急性阑尾炎的独立危险因素，IgE［OR=0.162（95%CI 0.062～0.424）］是其独立保护因素（均P0.05）。ROC分析结果显示，联合模型诊断AUC为0.924（95%CI 0.881～0.966），最佳阈值76.84；IgE的AUC为0.915（95%CI 0.867～0.962），最佳阈值106.0 μg/L。结论　血清CRP、IL-6、IL-13、IgE单独及联合均可用于儿童复杂性急性阑尾炎的鉴别诊断中，其中IgE单独与四项指标联合检测对于复杂性急性阑尾炎具有较好的预测价值。

关键词:

急性阑尾炎, 儿童, Ⅰ型超敏反应特异性标志物, C反应蛋白, 白细胞介素-6, 诊断