目的探讨血清胆红素升高在急性阑尾炎坏疽、穿孔中的诊断价值。 方法回顾性分析2011年6月至2013年8月期间我院住院行手术治疗的急性阑尾炎患者的临床病理资料，比较多种指标诊断急性复杂阑尾炎的准确性。 结果复杂阑尾炎患者血清总胆红素（STB）水平明显高于非复杂阑尾炎患者（P＜0.001）。STB升高诊断复杂阑尾炎的敏感性及特异性分别为33.3%和86.2%，而血清直接胆红素(SDB）升高（≥6.65μmol/L）诊断复杂阑尾炎的敏感性及特异性分别为78.1%和63.5%。系统炎症反应（SIRS）评分与STB联合诊断具最佳诊断效能，受试者操作特征曲线下面积为0.741，而血清白细胞计数（特异性40.7%）诊断准确性相对较低。 结论SDB升高诊断急性阑尾炎坏疽、穿孔的准确性较佳，STB与SIRS评分联合诊断可作为早期鉴别诊断复杂阑尾炎的参考指标。
ObjectiveTo investigate the trend of serum bilirubin in patients with liver cirrhosis before and after transjugular intrahepatic portosystemic shunt (TIPS).MethodsThe data of patients with cirrhotic portal hypertension who underwent TIPS between October 2016 and June 2018 were collected retrospectively, including liver function before and after surgery (1 week, 1 month, 3 months, and 6 months after surgery), preoperative and postoperative portal vein pressure, and the Child-Pugh scores, model for end-stage liver disease (MELD) scores, and albumin-bilirubin (ALBI) scores. Paired t-test was used for the statistical measurement data. The total bilirubin (TBIL), direct bilirubin (DBIL), and indirect bilirubin (IBIL) levels at five time points were analyzed by analysis of variance of repeated measurement data with its own before and after comparison, and Wilcoxon signed ranks test was used for the ordered data.ResultsA total of 60 patients were included.The portal vein pressure was (27.86±2.53) mm Hg (1 mm Hg=0.133 kPa) before TIPS and (17.22±2.33) mm Hg after TIPS, and the difference was statistically significant (P<0.05). The common logarithm of the serum TBIL level [lg(TBIL)] before surgery and 1 week, 1 month, 3 months, and 6 months after surgery were (1.27±0.23), (1.44±0.21), (1.51±0.20), (1.56±0.22), (1.48±0.19) lg(μmol/L), respectively, and the difference was statistically significant (P<0.001). The common logarithm of the serum DBIL level [lg(DBIL)] at the five time periods were (0.90±0.26), (1.14±0.24), (1.18±0.25), (1.21±0.28), (1.08±0.21) lg(μmol/L), respectively, and the difference was statistically significant (P<0.001). The common logarithm of the serum IBIL level [lg(IBIL)] at the five time periods were (1.00±0.23), (1.13±0.22), (1.20±0.23), (1.26±0.21), (1.22±0.23) lg(μmol/L), respectively, and the difference was statistically significant (P<0.001). There were no statistically significant differences in the three liver reserve function scores (Child-Pugh, MELD, and ALBI, respectively) before and six months after operation (P>0.05). The differences in the composition of Child-Pugh and ALBI before and after surgery were not statistically significant (P>0.05).ConclusionsTIPS has a significant effect on reducing portal hypertension. Serum bilirubin levels continue to increase during a period after TIPS, but begin to decrease within 6 months.