Diagnostic Value of Serum Bilirubin Level in Acute Appendicitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 杨晨 ¹ , 张捷 ¹ , 周荣幸 ¹ , 林圯昕 ¹ , 杨启晨 ² , 熊先泽 ¹ , 张捷 ¹ , 程南生 ¹

1. ;
2. 四川大学华西临床医学院(四川成都 610041);

Corresponding author：

Keywords：

复杂阑尾炎; 血清胆红素; 系统炎症反应评分

DOI：

10.7507/1007-9424.20140243

Video：

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目的探讨血清胆红素升高在急性阑尾炎坏疽、穿孔中的诊断价值。方法回顾性分析2011年6月至2013年8月期间我院住院行手术治疗的急性阑尾炎患者的临床病理资料，比较多种指标诊断急性复杂阑尾炎的准确性。结果复杂阑尾炎患者血清总胆红素（STB）水平明显高于非复杂阑尾炎患者（P＜0.001）。STB升高诊断复杂阑尾炎的敏感性及特异性分别为33.3%和86.2%，而血清直接胆红素(SDB）升高（≥6.65μmol/L）诊断复杂阑尾炎的敏感性及特异性分别为78.1%和63.5%。系统炎症反应（SIRS）评分与STB联合诊断具最佳诊断效能，受试者操作特征曲线下面积为0.741，而血清白细胞计数（特异性40.7%）诊断准确性相对较低。结论 SDB升高诊断急性阑尾炎坏疽、穿孔的准确性较佳，STB与SIRS评分联合诊断可作为早期鉴别诊断复杂阑尾炎的参考指标。

Citation： 杨晨, 张捷, 周荣幸, 林圯昕, 杨启晨, 熊先泽, 张捷, 程南生. Diagnostic Value of Serum Bilirubin Level in Acute Appendicitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(8): 1013-1015. doi: 10.7507/1007-9424.20140243 Copy

1.	Temple CL, Huchcroft SA, Temple WJ. The natural history of appendicitis in adults. A prospective study[J]. Ann Surg, 1995, 221(3): 278-281.
2.	Kearney D, Cahill RA, O'Brien E, et al. Influence of delays on perforation risk in adults with acute appendicitis[J]. Dis Colon Rectum, 2008, 51(12): 1823-1827.
3.	张伟耀, 邓惠玲, 朱峰正, 等.急性阑尾炎CT检查的辅助诊断价值及鉴别诊断思路[J].中国普外基础与临床杂志, 2013, 20(12): 1414-1416.
4.	Beltrán MA, Almonacid J, Vicencio A, et al. Predictive value of white blood cell count and C-reactive protein in children with appendicitis[J]. J Pediatr Surg, 2007, 42(7): 1208-1214.
5.	Blumfield E, Nayak G, Srinivasan R, et al. Ultrasound for differentiation between perforated and nonperforated appendicitis in pediatric patients[J]. AJR Am J Roentgenol, 2013, 200(5): 957-962.
6.	Hong YR, Chung CW, Kim JW, et al. Hyperbilirubinemia is a significant indicator for the severity of acute appendicitis[J]. J Korean Soc Coloproctol, 2012, 28(5): 247-252.
7.	Socea B, Carâp A, Rac-Albu M, et al. The value of serum bilirubin level and of white blood cell count as severity markers for acute appendicitis[J]. Chirurgia (Bucur), 2013, 108(6): 829-834.
8.	Tiwari MM, Reynoso JF, Tsang AW, et al. Comparison of outcomes of laparoscopic and open appendectomy in management of uncomplicated and complicated appendicitis[J]. Ann Surg, 2011, 254(6): 927-932.
9.	Miller DF, Irvine RW. Jaundice in acute appendicitis[J]. Lancet, 1969, 1(7590): 321-323.
10.	Sisson RG, Ahlvin RC, Harlow MC. Superficial mucosal ulceration and the pathogenesis of acute appendicitis[J]. Am J Surg, 1971, 122(3): 378-380.
11.	Rink RD, Kaelin CR, Giammara B, et al. Effects of live Escherichia coli and Bacteroides fragilis on metabolism and hepatic pO2[J]. Circ Shock, 1981, 8(5): 601-611.
12.	Sand M, Bechara FG, Holland-Letz T, et al. Diagnostic value of hyperbilirubinemia as a predictive factor for appendiceal perforation in acute appendicitis[J]. Am J Surg, 2009, 198(2): 193-198.
13.	Atahan K, Üreyen O, Aslan E, et al. Preoperative diagnostic role of hyperbilirubinaemia as a marker of appendix perforation[J]. J Int Med Res, 2011, 39(2): 609-618.
14.	Emmanuel A, Murchan P, Wilson I, et al. The value of hyperbilirubinaemia in the diagnosis of acute appendicitis[J]. Ann R Coll Surg Engl, 2011, 93(3): 213-217.
15.	McGowan DR, Sims HM, Zia K, et al. The value of biochemical markers in predicting a perforation in acute appendicitis[J]. ANZ J Surg, 2013, 83(1/2): 79-83.
16.	Noh H, Chang SJ, Han A. The diagnostic values of preoperative laboratory markers in children with complicated appendicitis[J]. J Korean Surg Soc, 2012, 83(4): 237-241.
17.	Nozoe T, Matsumata T, Sugimachi K. Significance of SIRS score in therapeutic strategy for acute appendicitis[J]. Hepatogastroenterology, 2002, 49(44): 444-446.

1. Temple CL, Huchcroft SA, Temple WJ. The natural history of appendicitis in adults. A prospective study[J]. Ann Surg, 1995, 221(3): 278-281.
2. Kearney D, Cahill RA, O'Brien E, et al. Influence of delays on perforation risk in adults with acute appendicitis[J]. Dis Colon Rectum, 2008, 51(12): 1823-1827.
3. 张伟耀, 邓惠玲, 朱峰正, 等.急性阑尾炎CT检查的辅助诊断价值及鉴别诊断思路[J].中国普外基础与临床杂志, 2013, 20(12): 1414-1416.
4. Beltrán MA, Almonacid J, Vicencio A, et al. Predictive value of white blood cell count and C-reactive protein in children with appendicitis[J]. J Pediatr Surg, 2007, 42(7): 1208-1214.
5. Blumfield E, Nayak G, Srinivasan R, et al. Ultrasound for differentiation between perforated and nonperforated appendicitis in pediatric patients[J]. AJR Am J Roentgenol, 2013, 200(5): 957-962.
6. Hong YR, Chung CW, Kim JW, et al. Hyperbilirubinemia is a significant indicator for the severity of acute appendicitis[J]. J Korean Soc Coloproctol, 2012, 28(5): 247-252.
7. Socea B, Carâp A, Rac-Albu M, et al. The value of serum bilirubin level and of white blood cell count as severity markers for acute appendicitis[J]. Chirurgia (Bucur), 2013, 108(6): 829-834.
8. Tiwari MM, Reynoso JF, Tsang AW, et al. Comparison of outcomes of laparoscopic and open appendectomy in management of uncomplicated and complicated appendicitis[J]. Ann Surg, 2011, 254(6): 927-932.
9. Miller DF, Irvine RW. Jaundice in acute appendicitis[J]. Lancet, 1969, 1(7590): 321-323.
10. Sisson RG, Ahlvin RC, Harlow MC. Superficial mucosal ulceration and the pathogenesis of acute appendicitis[J]. Am J Surg, 1971, 122(3): 378-380.
11. Rink RD, Kaelin CR, Giammara B, et al. Effects of live Escherichia coli and Bacteroides fragilis on metabolism and hepatic pO2[J]. Circ Shock, 1981, 8(5): 601-611.
12. Sand M, Bechara FG, Holland-Letz T, et al. Diagnostic value of hyperbilirubinemia as a predictive factor for appendiceal perforation in acute appendicitis[J]. Am J Surg, 2009, 198(2): 193-198.
13. Atahan K, Üreyen O, Aslan E, et al. Preoperative diagnostic role of hyperbilirubinaemia as a marker of appendix perforation[J]. J Int Med Res, 2011, 39(2): 609-618.
14. Emmanuel A, Murchan P, Wilson I, et al. The value of hyperbilirubinaemia in the diagnosis of acute appendicitis[J]. Ann R Coll Surg Engl, 2011, 93(3): 213-217.
15. McGowan DR, Sims HM, Zia K, et al. The value of biochemical markers in predicting a perforation in acute appendicitis[J]. ANZ J Surg, 2013, 83(1/2): 79-83.
16. Noh H, Chang SJ, Han A. The diagnostic values of preoperative laboratory markers in children with complicated appendicitis[J]. J Korean Surg Soc, 2012, 83(4): 237-241.
17. Nozoe T, Matsumata T, Sugimachi K. Significance of SIRS score in therapeutic strategy for acute appendicitis[J]. Hepatogastroenterology, 2002, 49(44): 444-446.

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Diagnostic Value of Serum Bilirubin Level in Acute Appendicitis

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