目的 探讨改良Alvarado评分联合MSCT诊断急性阑尾炎的临床价值。方法 收集有完整腹部CT检查资料的临床疑似 急性阑尾炎病例316例，计算改良Alvarado评分并将患者分为低，中，高分值组。计算MSCT诊断急性阑尾炎的准确 率、敏感性、特异性、PPV和NPV。通过χ2 检验比较急性阑尾炎与非急性阑尾炎的评分和差异，以及急性阑尾炎不 同分值组的诊断准确性及其差异。结果 316例疑似病例中102例经外科手术确诊，44例经内科保守治疗痊愈，170证 实为非急性阑尾炎。改良Alvarado评分高分值组患者182例，中分值组104例，低分值组30例。MSCT诊断急性阑尾炎 的准确率、敏感性、特异性、PPV和NPV分别为97.5%，98.6%，96.5%，96.0% 和 98.8%。复杂或不复杂急性阑尾炎 的评分明显高于非急性阑尾炎患者(P＜0.001)。急性阑尾炎高分值组诊断准确率最高，与其它组诊断准确率存在统 计学差异，且女性在对应组中诊断准确率低于男性。结论 MSCT对急性阑尾炎的术前诊断能力优于改良Alvarado评 分，但改良Alvarado评分有助于患者危险分层。

Objective To compare the value of modified Alvarado score and MSCT in the diagnosis of acute appendicitis. Methods 316 cases with suspected acute appendicitis on the going MSCT were included. The modified Alvarado score were retrospectively analyzed. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of MSCT in the diagnosis of acute appendicitis were estimated. The patients were divided into low, median, high groups according to the modified Alvarado score. The difference of the modified Alvarado score between patients with and without acute appendicitis and the distribution of acute appendicitis among different score groups were analyzed using χ2-test. Results Of 316 suspected cases, 102 (69.9%) were proven by surgical operation, 44 were cured by conventional medical management, and 170 were confirmed to be without acute appendicitis. The number of patients with low, median, high modified Alvarado score were 30(9.5%), 104(32.9%) and 182(57.6%). The accuracy of MSCT was 97.5%, while the sensitivity, specificity, positive predictive value and negative predictive value were 98.6%, 96.5%, 96.0% and 98.8%.The modified Alvarado score of patients with acute appendicitis was higher than that of patients without acute appendicitis(P<0.001). The diagnostic accuracy of modified Alvarado score in women was lower than men in all groups. Conclusion The performance of MSCT was better than that of modified Alvarado score for the diagnosis of acute appendicitis. However, Modified Alvarado score could be used for patient stratification.