婴幼儿急性阑尾炎穿孔的相关危险因素分析

Analysis of Risk Factors Associated with Acute Appendicitis Perforation in Infants

摘要: 目的：分析婴幼儿急性阑尾炎(AA)穿孔的独立危险因素。方法：回顾性分析我院2018年1月至2024年3月期间收治的85例急性阑尾炎婴幼儿的临床资料，依据术中阑尾穿孔情况及术后病理结果，将患儿分为穿孔组(n = 29)和非穿孔组(n = 56)。进一步对比两组患儿的性别、年龄、发病至入院时间、入院前最高体温、脉率、营养状况、术前是否使用抗生素、临床症状及体征、术前实验室检查结果等指标，并采用单因素分析比较两组间基线资料的差异，采用二元logistic回归方法，对穿孔性阑尾炎的独立危险因素进行筛选，同时绘制ROC曲线以评估预测效果。结果：85例急性阑尾炎患儿中穿孔29例，占34.12%，穿孔组患儿在发病至入院时间、入院前最高体温、营养状况、术前是否使用抗生素治疗、恶心/呕吐、腹部压痛、反跳痛、转移性右下腹痛、阑尾粪石和盆腹腔积液、血WBC和CRP水平与非穿孔组患儿比较有显著性差异(P < 0.05)。Logistic分析结果表明，发病至入院时间、入院前最高体温、阑尾粪石、血WBC及CRP水平是急性阑尾炎患儿发生穿孔的独立危险因素(P < 0.05)。进一步绘制ROC曲线显示，上述指标的曲线下面积分别为0.827、0.726、0.631、0.836和0.787 (P < 0.05)。各个指标联合预测穿孔性阑尾炎风险时曲线下面积为0.962，敏感度0.931，特异度0.893。结论：发病至入院时间、入院前最高体温、阑尾粪石、血WBC和CRP水平是婴幼儿急性阑尾炎伴穿孔的独立危险因素，各指标联合预测对阑尾炎穿孔的诊断价值更高。

Abstract: Objective: To analyze the independent risk factors for perforation in infants with acute appendicitis (AA). Methods: The clinical data of 85 infants and young children with acute appendicitis admitted to our hospital from January 2018 to March 2024 were retrospectively analyzed. Based on the intraoperative observation of the appendix and pathological results, patients were divided into two groups: perforated (n = 29) and non-perforated (n = 56). The two groups were compared in terms of gender, age, time from symptom onset to admission, maximum body temperature before admission, pulse rate, nutritional status, preoperative antibiotics use, clinical symptoms and signs, presence of fecaliths in the appendix, presence of ascites in the abdominal cavity, and preoperative laboratory test results. Univariate analysis was conducted to compare baseline characteristics between the two groups, followed by binary logistic regression to identify independent risk factors of perforated appendicitis. A receiver operating characteristic (ROC) curve was also constructed. Result: Among 85 children diagnosed with acute appendicitis, 29 cases (34.12%) experienced perforation. Significant differences were observed between the perforation and non-perforation groups in terms of time from symptom onset to hospital admission, highest pre-admission body temperature, nutritional status, preoperative antibiotic treatment, presence of nausea/vomiting, abdominal tenderness, rebound pain, migratory right lower quadrant pain, appendicolith, pelvic ascites, white blood cell (WBC) count, and C-reactive protein (CRP) levels (P < 0.05). Logistic regression analysis identified time from symptom onset to hospital admission, highest pre-admission body temperature, presence of appendicolith, WBC count, and CRP levels as independent risk factors for perforation in pediatric acute appendicitis (P < 0.05). The areas under the ROC curve for these indicators were 0.827, 0.726, 0.631, 0.836, and 0.787, respectively (P < 0.05). When combined, the area under the curve for predicting the risk of perforated appendicitis was 0.962, with a sensitivity of 0.931 and specificity of 0.893. Conclusion: The time from onset to admission, the highest body temperature prior to admission, presence of an appendicolith, and levels of WBC and CRP are independent risk factors for perforated acute appendicitis in infants and young children. The combined assessment of these indices provides greater diagnostic accuracy for identifying perforated acute appendicitis.