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題名 | Discriminant Analysis of Serum Inflammatory Biomarkers which Differentiate Pediatric Appendicitis from Other Acute Abdominal Diseases=以血清發炎標記之區辨分析來鑑別兒童闌尾炎與其他腹部急症 |
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作者 | 林坤辰; 吳漢屏; 黃靜宜; 林清淵; 張進富; | 書刊名 | 臺灣兒科醫學會雜誌 |
卷期 | 48:3 2007.05-06[民96.05-06] |
頁次 | 頁125-130+157 |
分類號 | 417.62441 |
關鍵詞 | 區辨分析; 血清標記; 急性腹部急症; 兒童闌尾炎; Discriminant analysis; Serum biomarker; Acute abdominal diseases; Pediatric appendicitis; |
語文 | 英文(English) |
中文摘要 | 背景:某些症狀與症候相似於兒童闌尾炎的腹部急症,可能因臨床表現類似急性闌尾炎而易產生誤診並造成不必要的闌尾切除手術。本研究利用血清發炎標記在急性闌尾炎的區辨分析,來探究有哪些特定的急性腹症無法與兒童闌尾炎區別,並依不同年齡層加以分析。方法:本研究採前瞻性分析小兒急診部417個從4歲到18歲在臨床上表現疑似是急性闌尾炎的病童。對於闌尾炎有顯著上升的血清標記當作區辨分析的變項。然後針對那些無法被區辨分析預測的非闌尾炎之腹部急症病童,去進一步分析他們最後的診斷。結果:急性闌尾炎的病人相較於正常闌尾的病人,有較顯著升高的白血球數量(p<0.01)、嗜中性白血球數量(p<0.01)以及C-反應蛋白濃度(p<0.01)。以此三個血清標記對急性闌尾炎的區辨力是百分之七十六。臨床症狀相似於闌尾炎且無法被區辨分析預測的急性腹症經分析後,包括以下四者:急性腸胃炎、非專一性腹痛、尿道感染、上呼吸道感染合併腸胃症狀。結論:血清發炎標記可以作為幫助兒童急性闌尾炎診斷的區辨者。而某些特定的急性腹症其臨床表現易與闌尾炎混淆,故在鑑別診斷時應將此等疾病優先列入考慮,以減少誤診的發生及避免不必要的闌尾切除手術。 |
英文摘要 | Background: Other acute abdominal diseases in children can confound the signs and symptoms of appendicitis, resulting in misdiagnosis and unnecessary appendectomy. In this study, we used discriminant analysis of serum inflammatory biomarkers to determine which acute abdominal diseases could mimic appendicitis, and further analyzed these diseases based on different age groups. Methods: We prospectively collected 417 patients aged from 4 to 18 years with clinically suspected acute appendicitis in the pediatric emergency department. We selected the significantly higher serum biomarkers for appendicitis as the discriminating variables. Furthermore, we analyzed the definitive diagnoses of patients with normal appendices who could not be predicted by discriminant analysis. Results: Patients with acute appendicitis had significantly higher leukocyte counts (p<0.01), neutrophil counts, (p<0.01) and C-reactive protein concentrations (p<0.01 ) than those with normal appendices. The discriminant power of these three serum biomarkers in acute appendicitis was 76 percent. Acute abdominal diseases which mimicked appendicitis included acute gastroenteritis, nonspecific abdominal pain, urinary tract infection, and upper respiratory infection with gastrointestinal upset. Conclusions: Serum biomarkers may serve as helpful discriminators to predict the presence of pediatric appendicitis. But, some acute abdominal diseases mimicking appendicitis should be considered during differential diagnosis of acute appendicitis to avoid making misdiagnosis and performing unnecessary appendectomy. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。