改良Alvarado、AIR、RIPASA和AAS评分对成人急性阑尾炎风险预测价值

The Risk Prediction Value of Modified Alvarado, AIR, RIPASA and AAS Scores in Adult Acute Appendicitis

摘要: 目的：急性阑尾炎是常见的急腹症之一，早期识别和治疗能有效降低急性阑尾炎发生坏疽穿孔等并发症。本研究旨在确定适合中国的成人急性阑尾炎的最佳风险预测模型。方法：回顾性收集了269例拟诊断且术后病理明确是急性阑尾炎患者的改良Alvarado、AIR、RIPASA和AAS评分相关数据，研究不同评分模型对中国成人急性阑尾炎的预测价值及风险评估。结果：共纳入269名疑似阑尾炎患者，平均年龄为38岁，男性156名(58%)，各组评分对单纯性及复杂性阑尾炎的预测具有意义(P < 0.01)，而改良Alvarado在评价阑尾炎坏疽穿孔时更有意义(P = 0.001)，中性粒细胞百分比在单纯性阑尾炎和化脓性或坏疽性阑尾炎时具有统计学意义(P = 0.015和P = 0.001)，CRP在单纯性和化脓性阑尾炎；单纯性和坏疽/穿孔性阑尾炎；化脓性与坏疽性阑尾炎之间均具有显著差异(P = 0.002, P < 0.001, P < 0.001)。参照受试者工作曲线，发现在评估复杂性急性阑尾炎的改良Alvarado评分的最佳评分为5.5，敏感性为76.3%，特异性为52%；而AAS评分最佳截断值为11.5，敏感性为92.2%，特异性为72%；改良Alvarado评分对坏疽/穿孔性阑尾炎的最佳评分为6.5，敏感性为71.2%，特异性为50.3%。结论：与RIPASA和AAS评分相比，改良Alvarado评分、AIR评分在评估急性阑尾炎坏疽穿孔方面具有最佳筛查性能，在识别急性阑尾炎患者时更有价值。

Abstract: Objective: Acute appendicitis is one of the common acute abdominal disease, early recognition and treatment can effectively reduce the occurrence of complications such as gangrene and perforation of acute appendicitis. The purpose of this study is to determine the best risk predic- tion model for adult acute appendicitis in China. Methods: The data of modified Alvarado, AIR, RIPASA and AAS score data, 269 patients with pathologically confirmed acute appendicitis were collected retrospectively. To find the predictive value of different scoring models for acute appendicitis in Chinese adults. Results: A total of 269 patients with suspected appendicitis were enrolled, with an average age of 38 years old and 156 males (58%). The scores were significant for the prediction of simple and complex appendicitis (P < 0.01). The modified Alvarado is more meaningful in evaluating gangrene and perforation of appendicitis (P = 0.001). The neutrophils is statistically significant in simple appendicitis and suppurative or gangrenous appendicitis (P = 0.015 and P = 0.001). There were significant differences in CRP between simple appendicitis and suppurative appendicitis, simple appendicitis and gangrenous/perforated appendicitis, suppu- rative appendicitis and gangrenous appendicitis (P < 0.002, P < 0.001, P < 0.001). According to the receiver operating characteristic curve (ROC), it was found that the best score of the modified Alvarado score for evaluating complex acute appendicitis was 5.5, the sensitivity was 76.3% and the specificity was 52%. The best cut-off value of AAS score was 11.5, the sensitivity was 92.2%, and the specificity was 72%. The best score of modified Alvarado score for gangrene/perforated appendicitis was 6.5, 71.2% and 50.3% respectively. Conclusion: Compared with RIPASA and AAS scores, modified Alvarado score and AIR score have the best screening performance in evaluating gangrene and perforation of acute appendicitis. It is more valuable in identifying patients with acute appendicitis.