Comparison of inflammatory response in the perioperative period of acute appendicitis with different pathological types
KANG Chunbo1 LI Wenqiang1 ZHENG Jianwei1 WANG Dezhong1 LIN Dapeng1 CHEN Xiufeng1 LIU Xuekai2 QU Jun1▲
1.General Surgery Department, Aerospace Center Hospital, Beijing 100049, China;
2.Clinical Laboratory Department, Aerospace Center Hospital, Beijing 100049, China
Abstract：Objective To investigate the changes of perioperative inflammatory response in patients with different pathological types of acute appendicitis and its clinical significance for preoperative diagnosis. Methods The perioperative clinical data of 126 patients with acute appendicitis in the Aerospace Center Hospital from June 2015 to January 2017 was analyzed retrospectively. The inflammatory response indicators of patients with acute simple appendicitis (ASA, group A), acute purulent appendicitis (APA, group B) and acute gangrenous appendicitis (AGA, group C) were compared and analyzed before operation and 1, 3, 5 d after operation. The inflammatory response indicators included the highest body temperature (HBT), peripheral white blood count (WBC), neutrophil percentage (NE%), peripheral blood neutrophil / lymphatic ratio (NLR), high sensitivity C reactive protein (hs-CRP) and procalcitonin (PCT). Results The indicators of postoperative inflammatory reaction of the three groups decreased gradually with the passage of time. The inflammatory indicators at 1, 3, 5 d after operation were significantly lower than those before operation, the inflammatory indicators at 3, 5 d after operation were lower than those at 1 d after operation, which at 5 d after operation were lower than those at 3 d after operation, the differences were statistically significant (P ＜ 0.05). Before operation, HBT, WBC, hs-CRP, PCT of group C were higher than those of group A and group B (P ＜ 0.05). The inflammatory indicators had no statistically significant differences between group A and group B at 1, 3, 5 d after operation (P ＞ 0.05). The WBC, NE%, hs-CRP, PCT and NLR in group C were significantly higher than those in group A and group B at 1, 5 d after operation, with statistically significant differences (P ＜ 0.05); the WBC, NLR, hs-CRP and PCT in group C were significantly higher than those in group A and group B at 3 d after operation, with statistically significant differences (P ＜ 0.05). Conclusion The indicators of inflammatory response play a very important role in the diagnosis of acute appendicitis and it is helpful for diagnosing AGA before operation, so as to determine the conditions of acute appendicitis and deal with the condition promptly. The inflammatory response of patients with AGA has a relatively slow recovery and a higher incidence of infection-related complications.
康春博1 李文强1 郑建伟1 王德仲1 林大鹏1 陈秀峰1 刘雪凯2 曲军1▲. 炎性反应在不同病理类型急性阑尾炎围术期的比较[J]. 中国医药导报, 2019, 16(20): 152-155.
KANG Chunbo1 LI Wenqiang1 ZHENG Jianwei1 WANG Dezhong1 LIN Dapeng1 CHEN Xiufeng1 LIU Xuekai2 QU Jun1▲. Comparison of inflammatory response in the perioperative period of acute appendicitis with different pathological types. 中国医药导报, 2019, 16(20): 152-155.
[1] Marcelo A. Beltrán. The Systemic Inflammatory Response in Patients with Appendicitis：a Progressive Phenomenon Indian [J]. Indian J Surg，2015，77（Suppl 3）：1050-1056.
[2] Abdullah Shuaib，Ali Shuaib，Zainab Fakhra，et al. Evaluation of modified Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis [J]. World J Emerg Med，2017，8（4）：276-280.
[3] Malyar AA，Singh B，Dar HM，et al. A comparative study of appendicitis inflammatory response（AIR）score with Alvarado score in diagnosis of acute appendicitis [J]. BMMR，2015，18（3）：72-76.
[4] Rathod S，Ali I，Bawa AP，et al. Development of the RIPASA score：a new appendicitis scoring system for the diagnosis of acute appendicitis [J]. Singapore Med J，2010， 51（3）：220-225.
[5] Andersson M，Kolodziej B，Andersson RE，et al. Randomized clinical trial of Appendicitis Inflammatory Response score-based management of patients with suspected appendicitis [J]. Br J Surg，2017，104（11）：1451-1461.
[6] Wilasrusmee C，Siribumrungwong B，Phuwapraisirisan S，et al. Developing and validating of Ramathibodi Appendicitis Score（RAMA-AS）for diagnosis of appendicitis in suspected appendicitis patients [J]. World J Emerg Surg，2017，12：49. doi：10.1186/s13017-017-0160-3.
[7] Van den Worm L，Georgiou E，De Klerk M. C-reactive protein as a predictor of severity of appendicitis [J]. S Afr J Surg，2017，55（2）：14-17.
[8] Beecher SM，Hogan J，O''Leary DP，et al. An Appraisal of Inflammatory Markers in Distinguishing Acute Uncomplicated and Complicated Appendicitis [J]. Dig Surg，2016， 33（3）：177-181.
[9] Kollár D，McCartan DP，Bourke M，et al. Predicting acute appendicitis? A comparison of the Alvarado score，the Appendicitis Inflammatory Response Score and clinical assessment [J]. World J Surg，2015，39（1）：104-109.
[10] Khan A，Riaz M，Kelly ME，et al. Prospective validation of neutrophil-to-lymphocyte ratio as a diagnostic and management adjunct in acute appendicitis [J]. Ir J Med Sci. 2017，25. doi：10.1007/s11845-017-1667-z.
[11] Ghimire R，Sharma A，Bohara S. Role of C-reactive Protein in Acute Appendicitis [J]. Kathmandu Univ Med J，2016，14（2）：130-133.
[12] Jung SK，Rhee DY，Lee WJ，et al. Neutrophil-to-lymphocyte count ratio is associated with perforated appendicitis in elderly patients of emergency department [J]. Aging Clin Exp Res，2017，29（3）：529-536.
[13] Al-Abed YA，Alobaid N，Myint F. Diagnostic markers in acute appendicitis [J]. Am J Surg，2015，209（6）：1043-1047.
[14] Ahmed N. C-Reactive Protein：An Aid For Diagnosis Of Acute Appendicitis [J]. Ayub Med Coll Abbottabad，2017， 29（2）：250-253.
[15] Kelly ME，Khan A，Riaz M，et al. The Utility of Neutrophil-to-Lymphocyte Ratio as a Severity Predictor of Acute Appendicitis，Length of Hospital Stay and Postoperative Complication Rates [J]. Dig Surg，2015，32（6）：459-463.
[16] 何缘，王然，郝静，等.中性粒细胞与淋巴细胞比值在脓毒症中的应用进展[J].医学综述，2017，23（18）：5953-3598.
[17] Aktimur R，Cetinkunar S，Yildirim K，et al. Neutrophil-to-lymphocyte ratio as a diagnostic biomarker for the diagnosis of acute mesenteric ischemia [J]. Eur J Trauma Emerg Surg，2016，42（3）：363-368.
[18] Yamashita H，Yuasa N，Takeuchi E，et al. Diagnostic value of procalcitonin for acute complicated appendicitis [J]. Nagoya J Med Sci，2016，78（1）：79-88.
[19] Vaziri M，Ehsanipour F，Pazouki A，et al. Evaluation of procalcitonin as a biomarker of diagnosis，severity and postoperative complications in adult patients with acute appendicitis [J]. Med J Islam Repub Iran，2014，28：50.
[20] 唐智亮，孙元水，章国良，等.降钙素原对急性穿孔性阑尾炎的预测作用及手术方式的影响[J].浙江临床医学2017，19（3）：451-453.
[21] Monsalve S，Ellwanger A，Montedonico S. White blood cell count and C-reactive protein together remain useful for diagnosis and staging of acute appendicitis in children [J]. S Afr Med J，2017，107（9）：773-776.
2019, Vol. 16 
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