探讨Alvarado评分、超声特征联合血清趋化因子CXC受体3（CXCR3）、T细胞激活性低分泌因子（RANTES）水平在儿童阑尾炎诊断及病理分型中的临床价值。

采用前瞻性研究方法，选取2020年1月至2024年12月西安医学院第二附属医院及渭南市中心医院收治的211例腹痛患儿，根据病理结果分腹痛组（89例）和阑尾炎组（122例）；阑尾炎组依据病理结果进一步分为单纯急性阑尾炎组（68例）与复杂急性阑尾炎组（54例）。收集所有患儿的一般资料，进行Alvarado评分、腹部超声检查，并采用ELISA法检测血清CXCR3、RANTES水平。采用受试者工作特征（ROC）曲线分析各指标及联合模型的诊断效能。运用相对危险度分析其在分型鉴别中的价值。

阑尾炎组患儿的症状持续时间、入院时体温、白细胞计数和C反应蛋白水平均长于或高于腹痛组（均P<0.001）。阑尾炎组患儿的Alvarado评分、血清CXCR3及RANTES水平以及超声阳性率均高于腹痛组（均P<0.001）。ROC曲线分析显示，Alvarado评分、超声特征、CXCR3、RANTES诊断阑尾炎的曲线下面积（AUC）分别为0.853、0.838、0.784、0.749；四者联合诊断的AUC提高至0.961（95% CI 0.925~0.983），敏感度为95.90%，特异度为84.27%。在阑尾炎分型中，复杂急性阑尾炎组的Alvarado评分、CXCR3、RANTES水平及超声阳性率均显著高于单纯急性阑尾炎组（均P<0.001）。相对危险度结果显示，高Alvarado评分、超声检查阳性、高CXCR3及高RANTES患儿患复杂急性阑尾炎的概率更高。

Alvarado评分、超声特征联合血清CXCR3、RANTES水平可显著提高儿童阑尾炎的诊断准确率，并对鉴别单纯与复杂急性阑尾炎具有重要临床价值。

To explore the clinical value of Alvarado score, ultrasound features, combined with serum CXC chemokine receptor 3 (CXCR3) and regulated on activation, normal T cell expressed and secreted (RANTES) levels in the diagnosis and pathological classification of pediatric appendicitis.

A prospective study was conducted. Totally 211 children with abdominal pain admitted to the Second Affiliated Hospital of Xi'an Medical University and Weinan Central Hospital were selected from January 2020 to December 2024. Complying with the pathological results, they were separated into the abdominal pain group (89 cases) and the appendicitis group (122 cases); the appendicitis group was further separated into the simple acute appendicitis group (68 cases) and the complex acute appendicitis group (54 cases) based on the pathological results. The general information of all the patients was collected. Alvarado scoring and abdominal ultrasound examination was performed, and serum CXCR3 and RANTES were detected by ELISA method. The diagnostic efficiency of each indicator and the combined model was analyzed using the receiver operating characteristic (ROC) curve. In addition, the relative risk was used to analyze their value in the classification identification process.

The duration of symptoms, the body temperature at admission, the white blood cell count and C-reactive protein levels of the children in the appendicitis group were longer or higher than those in the abdominal pain group (all P<0.001). The Alvarado score, serum CXCR3 and RANTES levels, and the positive rate of ultrasound in the appendicitis group were higher than those in the abdominal pain group (all P<0.001). ROC curve analysis showed that the area under the curve (AUC) values for diagnosing appendicitis using Alvarado score, ultrasound features, CXCR3, and RANTES were 0.853, 0.838, 0.784, and 0.749, respectively. The combined diagnostic performance of the four methods increased to 0.961 (95% CI: 0.925-0.983), with a sensitivity of 95.90% and a specificity of 84.27%. In the classification of appendicitis, the Alvarado score, CXCR3, RANTES levels, and ultrasound positive rate in the complex acute appendicitis group were obviously higher than those in the simple acute appendicitis group (all P<0.001). The relative risk results showed that patients with high Alvarado score, positive ultrasound results, high CXCR3, and high RANTES had a higher probability of developing complex acute appendicitis.

The combination of Alvarado score, ultrasound features, and serum CXCR3 and RANTES levels can obviously ameliorate the diagnostic accuracy for pediatric appendicitis and has important clinical value in differentiating simple and complex acute appendicitis.