CLIN CHEM:白介素-6可明显提高急诊UAP的早期诊断水平

2019-02-07 MedSci MedSci原创

急性腹痛(UAP)的早期诊断仍然较为苦难。UPA的大多数病因都与广泛的炎症有关。因此,研究人员假设使用白介素-6/或降钙素原定量炎症在UAP的急诊诊断中具有一定的价值。

这是一项由研究人员发起的前瞻性多中心诊断研究,纳入急诊科(ED)急性腹痛患者。治疗医师首先根据临床和医师指导的实验室评估对UAP临床判断后,随后经过成像判别,使用视觉模拟量表进行量化。两名独立专家使用包括组织学和随访在内的所有信息判定最终诊断和UAP分类(危及生命,因急性医学原因需要紧急手术和/或住院)。在中心实验室采用盲法测定白介素-6和降钙素原。

结果显示1038例患者中有376(36%)被判定为UAP。白介素-6 [ROC曲线下面积(area under the ROC, AUC) 0.80;95% CI, 0.77 0.82] vs降钙素原(AUC, 0.65;95% CI, 0.62 0.68)与临床判断(AUC, 0.69;95% CI, 0.65 0.72;P < 0.001)。白介素-6联合评价和临床判断可使AUC在出现时增加到0.83 (95% CI, 0.80 0.85),显像后增加到0.87 (95% CI, 0.84 0.89),提高了对UAP患者的正确识别(平均预测概率净改善:出现+19%;成像后,+ 15%;P < 0.001)。决策曲线分析记录了整个测试前概率范围内的增量值。临床判断/白介素-6算法排除了敏感性为97%UAP,特异性为93%UAP

研究表明,白介素-6可明显提高急诊UAP的早期诊断水平。

原始出处:

Tobias Breidthardt, Nora Brunner-Schaub, Catharina Balmelli, Inflammatory Biomarkers and Clinical Judgment in the Emergency Diagnosis of Urgent Abdominal Pain

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