儿童慢性扁桃体炎和腺样体肥大与EB病毒感染的相关性

儿童慢性扁桃体炎和腺样体肥大在临床上十分常见,主要与细菌和病毒感染有关.因为EB病毒具有嗜B淋巴细胞的特性,当我们在体外进行B细胞培养时加入EB病毒可以促进其增生,而同样EB病毒感染患儿的扁桃体炎和腺样体肥大的术后病理也显示B淋巴细胞大量增生.近年来EB病毒在疾病发病机制中的作用成为研究的热点,本文结合国内外最新文献对EB病毒相关疾病,尤其是儿童慢性扁桃体炎和腺样体肥大与EB病毒感染的相关性研究进展做一综述.     

睡眠呼吸障碍儿童扁桃体及腺样体组织细菌学分析

目的　探讨睡眠呼吸障碍（sleep disordered breathing,SDB）儿童扁桃体及腺样体组织的细菌学特点。方法　经多导睡眠图监测确诊的163例SDB患儿纳入研究,其中120例同时接受扁桃体及腺样体切除术,4例接受单纯扁桃体切除术,39例接受单纯腺样体切除术,124例接受扁桃体切除术的患儿按照有无扁桃体炎反复发作的病史分为两组,扁桃体炎组71例和无扁桃体炎组53例。术中取部分扁桃体和（或）腺样体组织进行细菌学检查。结果　120例患儿中的114例（95.00%）两个部位分离出的细菌种类相同,120例中有17例（14.17%）两个部位均感染了两种细菌,混合感染的细菌种类均相同。在各个季节两个部位中金黄色葡萄球菌和流感嗜血杆菌的检出率无显著性差异（扁桃体：χ2=8.538,P =0.201;腺样体：χ2=5.427,P =0.490）。有无慢性扁桃体炎病史的扁桃体组织内的各种细菌检出率无显著性差异（χ2=3.028,P =0.387）。结论　同一个SDB患儿的扁桃体和腺样体组织检出的细菌种类几乎相同,有无慢性扁桃体炎病史的扁桃体组织内的不同细菌检出率无显著性差异。     

儿童慢性扁桃体炎腺样体肥大360例临床分析

目的探讨儿童慢性扁桃体炎腺样体肥大的最佳诊断方法及治疗方案.方法回顾分析慢性扁桃体炎腺样体肥大患儿360例的临床资料,在全麻下行扁桃体摘除术,在鼻内窥镜下切除腺样体.结果治愈329例,占92%;伴卡他性中耳炎者在3个月内恢复正常;72例伴鼻窦炎者治愈68例,占94%.术后血气分析PCO2、PO2、pH值在1周内恢复正常.结论术前用鼻内窥镜检查,摄鼻咽侧位片,行CT检查等确诊腺样体肥大率高.术前及术后血气分析有助于确定手术和观察疗效.于鼻内窥镜下切除腺样体有很多优点.     

鼻内镜下儿童腺样体切除术

腺样体肥大是引起儿童分泌性中耳炎、鼻窦炎、阻塞性睡眠呼吸暂停的主要病因,长久不治还可导致颌面发育障碍及身体、智力发育迟缓。孙文海等等研究资料显示腺样体肥大是儿童常见病、多发病,在儿童中的发病率为9．9％～29．2％,好发于寒冷潮湿地区,5岁以上腺样体肥大患儿常并发慢性扁桃体炎,曲灵美等团研究资料显示手术切除肥大的扁桃体和腺样体是目前治疗儿童OSAS的首选方法。腺样体是咽淋巴环的重要组成部分,在正常生理情况下6-7岁时最大,青春期以后逐渐萎缩。     

儿童扁桃体与腺样体切除术后发热因素分析

目的 探讨儿童扁桃体和/或腺样体切除术后发热的相关因素,为手术治疗和护理提供参考.方法 收集408例因扁桃体和/或腺样体肥大引起阻塞性睡眠呼吸障碍(OSDB)行扁桃体和/或腺样体切除术患儿的相关资料,分析发热与术中出血量、性别、扁桃体腺样体大小、扁桃体炎史、鼻窦炎现状、手术时段、手术季节和手术部位的关系.结果 408例...     

扁桃体腺样体肥大患儿术前术后血气分析

目的探讨儿童病理性扁桃体腺样体肥大低通气对血气的影响。方法对已确诊的12例扁桃体肥大、8例腺样体肥大及21例扁桃体合并腺样体肥大患儿手术前的动脉血气分析进行检则并与术后对比。结果所有患儿术前均出现不同程度的动脉氧分压降低,二氧化碳升高,部分伴有低氧血症、高碳酸血症。比较术前、术后动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)均有统计学意义。结论扁桃体腺样体肥大可导致儿童长期慢性缺氧影响内环境平衡及生长发育,建议积极治疗。     

低温等离子射频扁桃体部分切除术治疗儿童阻塞性睡眠呼吸暂停低通气综合征

目的:探讨低温等离子射频扁桃体部分切除术治疗儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的可行性并观察疗效。方法:回顾性分析91例OSAHS患儿的临床资料,所有患儿无反复咽痛及扁桃体炎表现,主要阻塞病变为扁桃体及腺样体肥大,应用低温等离子射频行扁桃体部分切除术及腺样体消融术治疗。结果:术中出血1～2ml,无原发及继发性出血,术后疼痛轻微。随访12～22个月,所有患儿睡眠打鼾及张口呼吸均消失,无扁桃体再生及反复炎症发作。结论:低温等离子射频切除部分扁桃体治疗儿童OSAHS微创、安全、有效,适用于各年龄段的扁桃体为增生肥大病变的患儿,是一种较好的儿童OSAHS治疗方法。     

儿童分泌性中耳炎与上气道疾病的相关性分析

目的探讨儿童分泌性中耳炎(Secretory otitis media,SOM)与上气道疾病的关系。方法选择2013年2月至2015年3月期间,在青岛市立医院确诊的339例SOM患儿为病例组,选择同期就诊的206例正常儿童为对照组。对两组患儿每年慢性鼻炎、过敏性鼻炎、慢性鼻窦炎的发作次数、以及声导抗、电耳镜、儿童鼻内镜、鼻咽侧位片的检查结果进行分析。探讨儿童SOM与上气道疾病的相关性。结果病例组每年慢性鼻炎、过敏性鼻炎、慢性鼻窦炎发作次数、扁桃体肥大、腺样体肥大的比例分别为(6.25±3.14)次、(5.04±3.43)次、(1.04±2.08)次、50.7%、81.1%,均明显高于对照组(2.39±1.22)次、(0.41±1.17)次、(0.30±0.77)次、7.8%、12.6%,差异有统计学意义(P<0.05)单因素的回归分析结果显示,腺样体肥大Ⅲ°和Ⅳ°肥大、扁桃体肥大Ⅳ°大、过敏性鼻炎为儿童SOM的主要危险因素。结论腺样体肥大Ⅲ°和Ⅳ°肥大、扁桃体肥大Ⅳ°大、过敏性鼻炎为儿童SOM的主要危险因素。     

腺样体切除术对儿童慢性鼻窦炎的影响

目的:探讨腺样体切除术对儿童慢性鼻窦炎的影响.方法:慢性鼻窦炎患儿51例,其中单纯腺样体切除术17例,腺样体切除术加鼻窦开放术22例,单纯鼻窦开放术12例,术后随访6个月以上.结果:单纯腺样体切除组有效率88.2%,腺样体切除术加鼻窦开放组有效率100.0%,单纯鼻窦开放组有效率75.0%.腺样体切除术加鼻窦开放组和单纯鼻窦开放术组之间的有效率比较差异有统计学意义(P<0.05).结论;腺样体肥大与儿童慢性鼻窦炎发生密切相关,腺样体切除术是有效的辅助治疗措施.     

细菌感染与儿童腺样体肥大及其相关疾病

腺样体肥大是儿童最常见的疾病之一,可引起慢性扁桃体炎、分泌性中耳炎、儿童慢性鼻-鼻窦炎等并发症。针对腺样体肥大及其相关疾病的病因学研究,多从腺样体作为“储菌池”、腺样体肥大造成的机械性阻塞和腺样体免疫异常等方面进行研究。本文就腺样体肥大的微生物学与慢性扁桃体炎、分泌性中耳炎和慢性鼻窦炎的相关性进行综述。     

Subpopulation of adenoidal lymphocytes of recurrent infection in the upper respiratory tract

A subpopulation of adenoidal lymphocytes was determined by the E-and EAC-rosetting techniques in order to study an immunological profile of adenoids in 61 children with recurrent otitis media, rhinosinusitis or recurrent tonsillitis.Though there was no significant difference in E- and EAC-rosette forming cells of adenoid tissues from children with recurrent infection in the upper respiratory tract, our results indicated the following. (1) A higher proportion of EAC-rosette forming cells (EAC-RFC) without a change of E-RFC was found in the adenoids of children with recurrent tonsillitis than those without it. (2) The percentage of EAC-RFC appears to increase proportionally to the size of adenoid viewed on the X-ray film. (3) The higher percentage was more remarkable in cases with rhinosinusitis and recurrent otitis media. From the data obtained it is concluded that adenoids may play some part in immunity responses against infection in the upper respiratory tract reflecting adenoidal hypertrophy.     

儿童腺样体肥大与分泌性中耳炎病因的关系探讨

目的 探讨腺样体肥大与儿童分泌性中耳炎（SOM）病因的关系,提高对两者关联性疾病的认识。方法 回顾分析诊断有分泌性中耳炎、腺样体肥大、慢性扁桃体炎、小儿鼾症或阻塞性睡眠呼吸暂停综合征的住院儿童742例的资料,进行统计分析。结果 742例中有173例SOM,SOM中伴腺样体肥大的有65例,而腺样体肥大(包括伴有SOM)有570例,腺样体肥大中发生SOM的机率为11.40%。结论 单纯腺样体肥大不是引起SOM的主要因素,儿童SOM是多种因素综合导致的结果。     

Oxidants and antioxidants in tonsillar and adenoidal tissue in chronic adenotonsillitis and adenotonsillar hypertrophy in children

OBJECTIVE: The aim of the study is to determine the possible role of oxidants and antioxidants in the pathogenesis of chronic adenotonsillitis and adenotonsillar hypertrophy in children. PATIENTS AND METHODS: The children were divided into infection and hypertrophy groups, which were comparable according to age and gender distribution. The infection group was consisted of 20 children with the diagnosis of chronic adenotonsillitis and the hypertrophy group was made up of 19 children with adenotonsillar hypertrophy to whom adenotonsillectomy was performed. Preoperative blood levels of erythrocyte MDA, serum MDA, erythrocyte catalase and serum catalase, and adenoidal and tonsillar tissue levels of MDA and catalase were studied. RESULTS: There were significant increase in tonsil MDA, adenoid MDA, tonsil catalase and adenoid catalase levels in infection group (p<0.05). CONCLUSION: Oxidants and antioxidants are found to have an important role in the pathogenesis of adenotonsillar hypertrophy and chronic adenotonsillitis. These findings strengthen the hypothesis that indicates adenotonsillar hypertrophy and chronic adenotonsillitis are different diseases of the same tissues.     

The correlation between EBV viral load in the palatine tonsils of patients with recurrent tonsillitis and concurrent serum titers of VCA–IgG

Epstein–Barr virus (EBV) infection usually occurs in early childhood and can persist in palatine tonsil lymphocytes to induce tonsillitis at a later date. We have examined the presence of EBV in palatine tonsils and relationship between EBV-DNA quantity in tonsil tissues and VCA–IgG quantity in autologous sera. Tonsils were obtained from 36 patients, male 20 (55.6%), female 16 (44.4%) (mean age 7.96 ± 6.97 years), who underwent tonsils removal because of recurrent tonsillitis. Tissues were processed for real-time PCR and patient’s sera were assayed to determine VCA–IgG by VCA–IgG ELISA. In 27 out of 36 cases (75%), positive EBV-DNA reaction was found. However, statistical analysis showed no correlation between EBV-DNA quantity and VCA–IgG quantity. We conclude that tonsils of children can be colonized by EBV and that virus may have a direct and indirect role in recurrent tonsillitis and nasopharyngeal carcinoma.     

A potential role for arginase in recurrent infections and hypertrophy of tonsillar and adenoidal tissue

Since arginase has been found to be an arginine-depleting and nitric oxide synthase-regulating enzyme, the present study was devised to examine hypertrophied and infected tonsil and adenoid arginase activity in relation to a metabolic arginase-nitric oxide pathway and its association with disease processes. Tissues were taken from 32 children undergoing adenotonsillectomy. There was a statistically significant difference between the two tissue enzyme activities, with tonsillar arginase activity being higher than the corresponding adenoidal tissue (P < 0.005). This suggests a potential role for tissue arginase activity as an outcome module and a contributing factor in chronic recurrent infection and hypertrophy of tonsillar and adenoidal tissues. Received: 8 October 1998 / Accepted: 22 April 1999     

鼻用类固醇治疗儿童变应性鼻炎伴腺样体肥大疗效分析

目的 探讨儿童变应性鼻炎(AR)与腺样体肥大的关系, 评价鼻用类固醇治疗儿童变应性鼻炎伴腺样体肥大的疗效。方法 对照组为单纯腺样体生长儿童261例, 其中腺样体肥大190例(72.7%)。观察组为变应性鼻炎伴腺样体生长儿童162例, 其中腺样体肥大110例(67.2%)。两组均给予鼻用类固醇(丙酸氟替卡松喷剂)持续喷鼻3个月后于鼻内镜下复查。结果 对照组并发腺样体肥大构成比为72.7%,观察组并发腺样体肥大构成比为67.2%, 差异无统计学意义(χ²=1.16, P>0.05)。对照组采用鼻用类固醇治疗后有效腺样体体积减少112例(58.9%),观察组有效腺样体体积减小89例(80.9%)(χ²=19.04, P<0.01)。结论 经鼻用类固醇治疗, 变应性鼻炎伴腺样体肥大患儿腺样体体积减小程度较单纯腺样体肥大患儿明显。对变应性鼻炎合并腺样体肥大者可优先考虑应用鼻用类固醇激素。     

儿童腺样体肥大与分泌性中耳炎的关系研究

目的探讨腺样体肥大儿童中分泌性中耳炎发病情况及其影响因素。方法258例住院手术治疗的腺样体肥大的儿童,均常规进行病史采集、鼻咽侧位片、声导抗检查;对部分患儿进行鼻内镜检查录像,单盲评估腺样体肥大程度及其与咽鼓管咽口的关系。统计分析分泌性中耳炎发生率及其影响因素。结果在258病例中经声导抗检查证实合并分泌性中耳炎者108例（41.9％）,而病史中有明确听力减退主诉者仅27例（10.5％）;对合并和未合并分泌性中耳炎病例的相关影响因素统计分析发现,患儿性别、病程长短、腭扁桃体大小等因素对分泌性中耳炎发病无明显影响,低龄患儿、腺样体过度肥大、腺样体与咽鼓管园枕或咽口关系密切者发生分泌性中耳炎可能性大,多元回归分析证明其中影响最显著的因素是腺样体与咽鼓管园枕或咽口关系密切程度。结论有必要对所有腺样体肥大患儿常规进行听力学检查,以确认或除外分泌性中耳炎诊断。低龄患儿、腺样体过度肥大或与咽鼓管园枕及咽口关系密切是分泌性中耳炎的促发因素。     

Medical treatment for rhinosinusitis associated with adenoidal hypertrophy in children: an evaluation of clinical response and changes on magnetic resonance imaging

OBJECTIVES: The association between adenoidal hypertrophy and rhinosinusitis with upper airway inflammation is increasingly recognized; however, no study has used magnetic resonance imaging (MRI) to assess the changes in adenoid size after medical treatment of rhinosinusitis. METHODS: Thirteen children referred to a tertiary allergy clinic with symptoms of rhinosinusitis received medical treatment over a 4-month period. All underwent MRI before and after treatment. The medical treatment regimen comprised a short course of oral antibiotics and oral steroids and a longer course of oral antihistamines and intranasal steroids. RESULTS: The pretreatment MRI demonstrated enlarged adenoids and rhinosinusitis in all 13 children, with evidence of extensive rhinosinusitis in 9 of the 13. The treatment resulted in an improvement in overall symptom score; the most significant improvement was seen in mouth breathing. The posttreatment MRI showed a statistically significant reduction in adenoid size and adenoid/nasopharynx ratio, which was associated with a significant decrease in sinus involvement on MRI. CONCLUSIONS: There is a high association between adenoidal hypertrophy and rhinosinusitis in the context of an allergy clinic. Magnetic resonance imaging can document the changes in adenoid size associated with resolution of rhinosinusitis. Further studies are necessary to validate these pilot data and further assess the effects of medical treatment and the role of MRI in adenoidal hypertrophy.     

鼾症儿童腺样体肥大的声导抗分析

目的　观察分析鼾症儿童的声导抗。方法　选取75例3～8岁不同程度腺样体肥大鼾症儿童,进行声导抗测试,并记录结果和参数。结果　鼾症儿童腺样体肥大III 度中,出现A型曲线的几率低,明显低于50%,反之出现B和C型鼓室图的几率高,声反射引出率低,平均峰压低,与I度和II度差别明显,差异有统计学意义。结论　不同等级腺样体肥大对儿童的中耳影响不同,腺样体越大,引起儿童分泌性中耳炎的几率越大,程度越严重。     

糠酸莫米松鼻喷剂和孟鲁司特钠联合治疗儿童腺样体肥大的疗效观察

目的：探讨儿童腺样体肥大的非手术治疗方法及其疗效。方法联合使用糠酸莫米松鼻喷剂和孟鲁司特钠治疗儿童腺样体肥大30例,按照腺样体大小分为轻度12例、中度11例、重度7例三组,同时按照有无变应性鼻炎分为伴变应性鼻炎组19例和不伴变应性鼻炎组11例。患者的症状评分根据Carlos O’Connor-Reina的家长调查问卷获得。结果轻度组中有效率91.7%（11/12）,中度组有效率63.6%（7/11）,重度组有效率14.3%（1/7）。伴变应性鼻炎组有效率73.7%（14/19）,不伴变应性鼻炎组有效率36.4%（4/11）。结论糠酸莫米松鼻喷剂联合孟鲁司特钠是非手术治疗腺样体肥大一个较好的方法,但各组效果不一。轻度腺样体肥大效果较好,重度腺样体肥大效果较差。对于伴有变应性鼻炎的腺样体肥大治疗效果明显优于不伴有变应性鼻炎的。