超声征象对小儿急性阑尾炎分型诊断及与免疫特征的关系

Value of ultrasonographic signs in the classification of pediatric acute appendicitis and their association with immune characteristics

摘要

目的 探讨超声征象对小儿急性阑尾炎(AAS)分型诊断及与免疫特征的关系。方法 回顾性分析2021年9月至2024年2月滁州市第一人民医院收治的167例AAS患儿的临床资料和超声图像。以手术病理结果为金标准,评估超声诊断符合率,利用受试者工作特征(ROC)曲线及曲线下面积(AUC)分析超声检测对AAS患儿不同病理分型的诊断效能。通过Logistic回归分析影响不同分型AAS的重要因素,基于结果构建临床模型(模型1)、临床特征+超声征象模型(模型2)。以沙普利加性解释(SHAP)评估各模型中各因素诊断AAS分子分型的贡献价值。结果 AAS患儿不同分型超声诊断准确率为96.41%(161/167)。超声与病理检查在AAS患儿不同分型评估中的符合率均较高(90%),一致性程度Kappa为0.861(P<0.001);超声检查诊断AAS患儿化脓性阑尾炎、坏疽性阑尾炎的效能较高(AUC值分别为0.718、0.817),而对单纯性阑尾炎的诊断效能较低(AUC=0.534);模型1是诊断单纯性阑尾炎、化脓性阑尾炎的最佳模型(AUC值分别为0.721、0.748),模型2是诊断坏疽性阑尾炎的最佳模型(AUC=0.725);SHAP分析结果显示IL-6、IL-17、CD4⁺/CD8⁺、管壁连续性、靶环征对诊断AAS病理分型的贡献价值均较高。结论 超声检查在急性阑尾炎患儿不同分型中的诊断准确率高,尤其对化脓性和坏疽性阑尾炎具有较高的诊断效能。临床特征联合超声征象的模型有助于提高诊断效率,且IL-6、IL-17、CD4⁺/CD8⁺、管壁连续性中断及靶环征对急性阑尾炎患儿病理分型的诊断贡献显著。

Abstract

Objective To investigate the diagnostic value of ultrasonographic signs in the classification of pediatric acute appendicitis (AAS) and their relationship with immune characteristics. Methods A retrospective analysis was conducted on the clinical data and ultrasonographic images of 167 pediatric patients with AAS admitted to The First People's Hospital of Chuzhou between September 2021 and February 2024. Using surgical pathology as the gold standard, the diagnostic accuracy of ultrasonography was evaluated. The diagnostic performance of ultrasonography for different pathological types of AAS was analyzed using receiver operating characteristic (ROC) curves and the area under the curve (AUC). Significant factors influencing the different AAS types were identified via logistic regression analysis, leading to the construction of two models: Model 1 (clinical model) and Model 2 (clinical features plus ultrasonographic signs). Shapley Additive Explanations (SHAP) were used to evaluate the contribution of each factor to the pathological types of AAS within the models. Results The overall diagnostic accuracy of ultrasonography for different AAS types was 96.41% (161/167). The concordance between ultrasonographic and pathological assessments was high (90%), showing good consistency (Kappa=0.861, P<0.001). Ultrasonography showed higher diagnostic performance for purulent and gangrenous appendicitis (AUC=0.718 and 0.817, respectively) but lower efficacy for simple appendicitis (AUC=0.534). Model 1 was the optimal model for diagnosing simple and purulent appendicitis (respectively AUC=0.721 and 0.748), while Model 2 was the best for diagnosing gangrenous appendicitis (AUC=0.725). SHAP analysis indicated that IL-6, IL-17, CD4 ⁺/CD8 ⁺ ratio, wall discontinuity, and the target sign were among the most influential factors for the diagnosis of AAS pathological subtypes. Conclusion Ultrasonography demonstrates high diagnostic accuracy for different pathological types of pediatric AAS, particularly for purulent and gangrenous appendicitis. The model combining clinical features with ultrasonographic signs further enhances diagnostic efficiency. IL-6, IL-17, CD4 ⁺/CD8 ⁺ ratio, interruption of wall continuity, and the target sign contribute significantly to the differentiation of AAS pathological subtypes.

关键词

儿童 / 急性阑尾炎 / 病理分型 / 超声征象 / 免疫特征

Key words

child / acute appendicitis / pathological classification / ultrasonographic sign / immune characteristic

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