Abstract: Objective　To investigate the value of RIPASA score，serum total bilirubin （TBil） and C-reactive protein （CRP） in the diagnosis of acute appendicitis.Methods　We enrolled 250 consecutive appendicitis patients with an acute pain in the lower right abdomen as the complaint at admission from the Second Affiliated Hospital of Xinjiang Medical University from January 2016 to January 2017.Based on the findings of laparoscopic appendectomy and pathological examination of the surgical specimen，150 with acute appendicitis and 100 with non-acute appendicitis were assigned to the acute appendicitis group〔including 18 with simple acute appendicitis （subgroup A），76 with suppurative acute appendicitis （subgroup B） and 56 with acute perforated gangrenous appendicitis （subgroup C）〕，and non-acute appendicitis group，respectively.RIPASA score was assessed and TBil and CRP were measured at admission.ROC analyses of the RIPASA score and TBil and CRP levels for the diagnosis of acute appendicitis，and of TBil and CRP levels for the diagnosis of acute perforated gangrenous appendicitis were performed.Results　Compared with non-acute appendicitis group，the RIPASA score，TBil and CRP levels were all higher in the acute appendicitis group （P<0.001）．Subgroup A showed lower average RIPASA score compared with other two subgroups （P<0.05）．Subgroup C demonstrated higher average TBil level compared with other two subgroups （P<0.05）．The average CRP level increased successively in subgroups A，B and C （P<0.05）．For the diagnosis of acute appendicitis，the optimal cutoff value，accuracy，sensitivity，specificity，and the area under the ROC curve （AUC） of RIPASA score were 7.5，82.4%，88.7%，73.0%，0.89〔95%CI（0.84，0.93），P<0.001〕，respectively，and those of the TBil level were 14.15 μmol/L，84.4%，88.7%，78.0%，0.86〔95%CI（0.81，0.90），P<0.001〕，respectively，and those of the CRP level were 13.6 mg/L，84.0%，88.0%，78.0%，0.88〔95%CI（0.84，0.92），P<0.001〕，respectively.For the diagnosis of acute perforated gangrenous appendicitis，the optimal cutoff value，accuracy，sensitivity，specificity，and the AUC of TBil level were 20.28 μmol/L，80.0%，89.3%，74.5%，0.89〔95%CI（0.82，0.93），P<0.001〕，respectively，and those of the CRP level were 34.00 mg/L，76.0%，82.1%，72.3%，0.82〔95%CI（0.75，0.88），P<0.001〕，respectively.Conclusion　RIPASA score，TBil and CRP were valuable for the diagnosis of acute appendicitis.Moreover，TBil and CRP were shown to be able to predict the acute perforated gangrenous appendicitis.

Key words: Appendicitis, RIPASA score, Bilirubin, C-reactive protein, Appendectomy, Diagnosis, Sensitivity, Specificity

摘要： 目的　探讨RIPASA评分、血清总胆红素（TBil）、C反应蛋白（CRP）在急性阑尾炎中的诊断价值。方法　选取2016年1月—2017年1月新疆医科大学第二附属医院收治的250例急性右下腹痛患者，根据腹腔镜阑尾切除术及病理检查结果将其分为急性阑尾炎组（150例）和非急性阑尾炎组（100例），急性阑尾炎组根据病理类型分为A亚组（单纯性阑尾炎18例）、B亚组（化脓性阑尾炎76例）、C亚组（坏疽穿孔性阑尾炎56例）。入院时对患者行RIPASA评分，并检测TBil及CRP水平，采用受试者工作特征（ROC）曲线分析其诊断价值。结果　急性阑尾炎组RIPASA评分、TBil、CRP水平均高于非急性阑尾炎组（P<0.001）。B亚组RIPASA评分、CRP水平均高于A亚组（P<0.05）；C亚组RIPASA评分、TBil、CRP水平均高于A亚组，TBil、CRP水平均高于B亚组（P<0.05）。RIPASA评分诊断急性阑尾炎的最佳临界值为7.5分，准确率为82.4%，灵敏度为88.7%，特异度为73.0%，ROC曲线下面积（AUC）为0.89〔95%CI（0.84，0.93），P<0.001〕；TBil诊断急性阑尾炎的最佳临界值为14.15 μmol/L，准确率为84.4%，灵敏度为88.7%，特异度为78.0%，AUC为0.86〔95%CI（0.81，0.90），P<0.001〕；CRP诊断急性阑尾炎的最佳临界值为13.6 mg/L，准确率为84.0%，灵敏度为88.0%，特异度为78.0%，AUC为0.88〔95%CI（0.84，0.92），P<0.001〕。TBil诊断坏疽穿孔性阑尾炎的最佳临界值为20.28 μmol/L，准确率为80.0%，灵敏度为89.3%，特异度为74.5%，AUC为0.89〔95%CI（0.82，0.93），P<0.001〕；CRP诊断坏疽穿孔性阑尾炎的最佳临界值为34.0 mg/L，准确率为76.0%，灵敏度为82.1%，特异度为72.3%，AUC为0.82〔95%CI（0.75，0.88），P<0.001〕。结论　RIPASA评分、TBil、CRP对急性阑尾炎均有诊断价值；TBil、CRP可以预测坏疽穿孔性阑尾炎。

关键词: 阑尾炎, RIPASA评分, 胆红素, C反应蛋白质, 阑尾切除术, 诊断, 灵敏度, 特异度