장중첩증에 있어 육안적 혈변의 진단적 가치 = The Diagnostic Value of Gross Bloody Stool on Intussusception

국문 초록 (Abstract)

목 적 : 장중첩증의 예측인자로서 육안적 혈변이 갖는 진단적 가치를 알아보고자 하였다.방 법 : 2001년 1월부터 2003년 12월까지 본원에서 장중첩증을 진단하기 위하여 초음파 검사를 시행했던 159명 환아의 병력 기록을 검토하여 각 증상을 비교하고 육안적 혈변이 갖는 진단적 가치를 조사하였다.결 과 : 159명 환아 중 36명이 장중첩증으로 진단되었다. 36명 환아 중 19명(52.8%)이 남아였고, 28명(77.8%)이 2세 미만이었다. 가장 흔한 증상은 간헐적인 복통 또는 보챔이었으나 실제로 장중첩증으로 진단된 비율은 24.2%로 육안적 혈변(50.9%)에 비해 작았다. 장중첩증이 의심되는 환아에서 육안적 혈변의 민감도와 특이도, 양성 예측률 그리고 음성 예측률은 아래와 같았다; 민감도는 77.8%(95% 신뢰구간 60.8-89.9), 특이도 78.0%(95% 신뢰구간 69.7-85.0) 양성 예측률 50.9%(95% 신뢰구간 37.1- 64.6), 음성 예측률 92.3%(95% 신뢰구간 85.4-96.6)였다(진단적 정확도 78.0%; 95% 신뢰구간 70.7-84.2).

다국어 초록 (Multilingual Abstract)

Purpose:To evaluate the diagnostic value of gross bloody stools as a predictor of intussusception.
Methods:We reviewed 159 cases retrospectively that had an ultrasound examination for diagnosis of intussusception from January 2001 to December 2003 at Ilsin Christian Hospital. We compared each symptom and assessed the diagnostic value of gross bloody stools in the patients with suspected intussusception.
Results:Thirty-six of the 159 patients had intussusception. Of 36 patients with intussusception, 19 (52.8%) children were male and 28(77.8%) children were younger than two years. The most common symptom was intermittent abdominal pain or irritability. But its frequency among the intussusception (24.2%) was lower than frequency of gross bloody stools(50.9%). The sensitivity, specificity, positive predictive value(PPV) and negative predictive value(NPV) of gross bloody stools in patients with suspected intussusception were as follows; sensitivity=77.8%(95% CI 60.8-89.9), specificity=78.0%(95% CI 69.7-85.0), PPV=50.9%(95% CI 37.1-64.6), NPV=92.3%(95% CI 85.4-96.6)(Diagnostic accuracy 78.0 %; 95% CI 70.7-84.2).
Conclusion:It is useful for diagnosis of intussusception to confirm the presence of gross blood in stools.

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