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OA

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.