简介 急性阑尾炎是急性腹痛的常见原因。 穿孔率高达20%。急性阑尾炎的诊断通常是通过众所周知的临床体征和症状。 放射成像通常是在体征和症状不明显的特殊病例中进行的。 尽管有多种评分方法可用于筛查和诊断，但这些方法不足以准确预测急性阑尾炎的严重程度。 从差异计数来看，中性粒细胞与淋巴细胞比率（NLR）是亚临床炎症的一种经济且直接的测量方法。 NLR 可能是预测阑尾炎发病和严重程度的有用标记，因为它可以洞察免疫和炎症途径。在这项研究中，我们的目的是确定印度泰米尔纳德邦一家三级护理医院成人患者 NLR 与急性阑尾炎之间的关联，以区分穿孔和非穿孔阑尾炎。方法 这是一项横断面研究，在泰米尔纳德邦钦奈一所大学的普通外科系进行。 该研究于2022年3月至2022年12月进行。研究纳入了年龄18岁及以上接受阑尾切除手术的患者。 患有血液学疾病、慢性肾病、慢性肝病、慢性阻塞性肺病、哮喘、癌症或自身免疫性疾病以及任何病毒、细菌或寄生虫感染的患者被排除在外。 孕妇也被排除在研究之外。 征得患者知情同意后，在诊断为急性阑尾炎时采集血样。 使用自动血液分析仪对完整血象进行实验室分析，包括白细胞 (WBC) 计数、中性粒细胞和淋巴细胞计数。 穿孔性阑尾炎的患病率以百分比形式报告。 为 NLR 开发区分穿孔和非穿孔阑尾炎的受试者工作特征 (ROC) 曲线。 数据输入到 Microsoft Excel 2023 中。这些分析是在 STATA 12.0（StataCorp，College Station，德克萨斯州，美国）中进行的。结果共有212名年龄18岁及以上的患者纳入研究。 其中男性93人（43.9%），女性119人（56.1%）。 术中观察到穿孔性阑尾炎的患病率为 29.7%，非穿孔性阑尾炎的患病率为 70.3%。穿孔性阑尾炎患者的 NLR 平均值 (SD) 为 8.8 (5.1)，非穿孔性阑尾炎患者为 3.2 (2.4)，具有统计学显着性差异（p 值 < 0.0001）。 ROC曲线的截止值为3.78 NLR，区分穿孔和非穿孔阑尾炎的敏感性为65.9%，特异性为93.1%。 阳性预测值 (PPV) 和阴性预测值 (NPV) 分别为 85.7% 和 81.2%。结论 NLR在鉴别穿孔性阑尾炎和非穿孔性阑尾炎方面具有合理的有效性。 NLR 在资源匮乏的环境中可能很有用，因为这些环境无法进行计算机断层扫描等常规放射学确认程序。版权所有 © 2024，Sidharth R 等人。

Introduction Acute appendicitis is a common reason for acute abdominal pain. It has a high perforation rate of 20%. Diagnosis of acute appendicitis is usually through well-known clinical signs and symptoms. Radiologic imaging is by and large carried out in peculiar cases with indistinct signs and symptoms. Although various scoring methods are available for screening and diagnosis, those have inadequate validity to accurately predict the severity of acute appendicitis. From the differential counts, the neutrophil-to-lymphocyte ratio (NLR) is an economical and straightforward measure of subclinical inflammation. NLR may be a useful marker for predicting the onset and severity of appendicitis because of the insight it gives into immunological and inflammatory pathways. In this study, we aimed to determine the association between NLR and acute appendicitis among adult patients to differentiate between perforated and non-perforated appendicitis in a tertiary care hospital in Tamil Nadu, India. Methods This was a cross-sectional study conducted in the Department of General Surgery of a deemed university in Chennai, Tamil Nadu. The study was conducted from March 2022 to December 2022. Patients aged 18 years and above undergoing appendicectomy surgery were included in the study. Patients with hematology disorders, chronic kidney disease, chronic liver disease, chronic obstructive pulmonary disease, asthma, cancer, or auto-immune diseases, and any viral, bacterial, or parasitic infections were excluded. Pregnant women were also excluded from the study. After obtaining informed consent from the patients, blood samples were collected as and when they were diagnosed as acute appendicitis. Laboratory analysis for complete hemogram including white blood cell (WBC) count, neutrophil, and lymphocyte count was carried out using an automated hematology analyzer. Prevalence of perforated appendicitis was reported as a percentage. The receiver-operating characteristic (ROC) curve was developed for NLR in differentiating perforated and non-perforated appendicitis. Data were entered in Microsoft Excel 2023. These analyses were carried out in STATA 12.0 (StataCorp, College Station, Texas, USA). Results A total of 212 patients aged 18 years and above were included in the study. Among them 93 (43.9%) were male and 119 (56.1%) were female. Prevalence of perforated appendicitis observed intra-operatively was 29.7% and non-perforated appendicitis was 70.3%. The mean (SD) of NLR among patients with perforated appendicitis was 8.8 (5.1) and non-perforated appendicitis was 3.2 (2.4) with a statistically significant difference (p-value < 0.0001). ROC curve with a cut-off value of 3.78 NLR, had sensitivity of 65.9% and specificity of 93.1% in differentiating perforated and non-perforated appendicitis. The positive predictive value (PPV) and negative predictive values (NPV) were reported as 85.7% and 81.2%, respectively. Conclusion NLR has a reasonable validity in differentiating perforated and non-perforated appendicitis. NLR may be useful in low-resource settings where routine confirmatory radiological procedures like computed tomography scans are not available.Copyright © 2024, Sidharth R et al.