血液及尿液分析对肾绞痛和阑尾炎的诊断价值研究

doi:10.12114/j.issn.1007-9572.2021.00.486

摘要/Abstract

摘要： 背景　阑尾炎、肾绞痛是引起急性非创伤性腹痛的常见疾病，是否可以通过常用的辅助检查血液及尿液分析即可诊断肾绞痛和阑尾炎，将成为医疗条件有限的医疗机构需要关注的问题。目的　探讨血液分析、尿液分析在肾绞痛及阑尾炎诊断上的意义。方法　选取2019年1—12月中山大学附属第六医院确诊为阑尾炎（阑尾炎组）或肾绞痛（肾绞痛组）患者117例。收集两组患者的一般资料、血液分析结果、尿液分析结果。对两组患者血液分析指标白细胞计数（WBC）、红细胞计数（RBC）、中性粒细胞计数（NEUT）、中性粒细胞比值（NEUT%）、血白红细胞比，以及尿液分析指标尿白细胞计数（UWBC）、尿红细胞计数（URBC）、尿白红细胞比进行比较。并采用受试者工作特征（ROC）曲线分析以上指标的诊断价值。结果　两组患者血液分析指标WBC、RBC、NEUT、NEUT%、血白红细胞比比较，差异均无统计学意义（P>0.05）；而阑尾炎患者尿液分析指标URBC、UWBC水平低于肾绞痛患者，尿白红细胞比高于肾绞痛患者（P<0.05）。URBC诊断肾绞痛的临界值为14.52/μl，灵敏度为0.892，特异度为0.864，AUC为0.921〔95%CI（0.877，0.964），P<0.01〕；UWBC诊断肾绞痛的临界值为16.5/μl，灵敏度为0.486，特异度为0.864，AUC为0.705〔95%CI（0.628，0.782），P<0.01〕，尿白红细胞比诊断阑尾炎的临界值为0.922，灵敏度为0.838，特异度为0.606，AUC为0.742〔95%CI（0.662，0.822），P<0.01〕。结论　URBC、UWBC对肾绞痛有较好诊断价值，尿白红细胞比对阑尾炎有诊断价值。

关键词: 急腹症；肾绞痛；阑尾炎；血液化学分析；尿分析；诊断, 鉴别；灵敏度；特异度

Abstract: Background　Appendicitis and renal colic are two common causes of acute non-traumatic abdominal pain.Whether they can be diagnosed by common laboratory blood and urine analyses has become a focus of medical institutions with limited medical resources.Objective　To explore the predictive value of blood and urine analyses for renal colic and appendicitis.Methods　From January to December 2019，117 patients with a definite diagnosis of appendicitis or renal colic were recruited from The Sixth Affiliated Hospital of Sun Yat-sen University.General clinical data，results of laboratory blood and urine analyses were collected.Laboratory blood indicators〔white blood cell（WBC） count，red blood cell（RBC） count，neutrophil（NEUT） count，neutrophil percentage（NEUT%），ratio of WBCs to RBCs〕，and urine indicators〔WBC count，RBC count and ratio of WBC count to RBC count in urine〕 were compared between appendicitis and renal colic patients，and the predictive value of indicators with significant intergroup differences for renal colic and appendicitis was estimated using the receiver operating characteristic（ROC） curve analysis.Results　Appendicitis and renal colic patients demonstrated no significant differences in mean WBC count，RBC count and NEUT count，NEUT% and ratio of WBC count to RBC count（P>0.05）.But appendicitis patients had lower mean RBC count and WBC count in urine，and higher ratio of WBC count to RBC count in urine（P<0.05）.So the ROC curve for estimating the predictive value of RBC count，WBC count，and ratio of WBC count to RBC count in urine for renal colic was plotted and the analysis revealed that the AUC of RBC count in urine was 0.921〔95%CI（0.877，0.964），P<0.01〕，with 0.892 sensitivity，0.864 specificity when the optimal cut-off value was chosen as 14.52/μl；the AUC of WBC count in urine was 0.705〔95%CI（0.628，0.782），P<0.01〕，with 0.486 sensitivity，0.864 specificity when the optimal cut-off value was chosen as 16.5/μl.The ROC curve for estimating the predictive value of RBC count，WBC count and ratio of WBC count to RBC count in urine for appendicitis was plotted and the analysis demonstrated that the AUC of ratio of WBC count to RBC count in urine was 0.742〔95%CI（0.662，0.822），P<0.01〕，with 0.838 sensitivity，0.606 specificity when the optimal cut-off value was chosen as 0.922.Conclusion　RBC count，WBC count in urine may have good diagnostic value for renal colic，and the ratio of WBC count to RBC count in urine may have good diagnostic value for appendicitis.

Key words: Abdomen, acute；Renal colic；Appendicitis；Blood chemical analysis；Urinalysis；Diagnosis, differential；Sensitivity；Specificity

陈小兵,吴桂昌. 血液及尿液分析对肾绞痛和阑尾炎的诊断价值研究[J]. 中国全科医学, 2021, 24(17): 2198-2201. DOI: 10.12114/j.issn.1007-9572.2021.00.486.
CHEN Xiaobing,WU Guichang. Predictive Values of Blood and Urine Analyses for Renal Colic and Appendicitis　[J]. Chinese General Practice, 2021, 24(17): 2198-2201. DOI: 10.12114/j.issn.1007-9572.2021.00.486.

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