阻塞性睡眠呼吸暂停综合征患儿T细胞亚群水平及相关指标的分析

目的 :检测阻塞性睡眠呼吸暂停综合征 (OSAS)患儿外周血T细胞亚群的变化 ,探讨OSAS对其细胞免疫功能的影响。方法 :应用APAAP桥联酶标法测定OSAS组和正常对照组外周血淋巴细胞表型 ,并将结果与睡眠检测指标进行相关性分析。结果 :OSAS组与正常对照组比较 ,CD4 、CD8 、CD4 /CD8 差异均有统计学意义 (均P <0 .0 1) ;CD4 、CD8 、CD4 /CD8 与呼吸暂停指数无相关性 ;与最低血氧饱和度 (LSaO2 )和病程有相关性 ,LSaO2 越低、病程越长 ,对T细胞亚群的影响越大 (P <0 .0 5 )。结论 :OSAS患儿细胞免疫功能低下。     

Serum immunoglobulins in patients with chronic tonsillitis

Serum immunoglobulin (IgG, IgA and IgM) levels were determined in patients with chronic tonsillitis before and one month after tonsillectomy. The preoperative levels of serum IgG, IgA and IgM were significantly higher when compared with the controls. The increase may be due to repeated antigenic stimulation. The post-operative levels for the three immunoglobulins were decreased; however, a significant reduction was observed for IgG only where the mean value was comparable with the control group. The data confirm that tonsillectomy does not disturb the humoral immune system of the body.     

鼻息肉组织中T—细胞亚群的分布及2种白细胞介素表达？…

目的 探讨Ｔ－淋巴细胞及细胞因子白细胞介素（ｉｎｔｅｒｌｅｕｋｉｎ,ＩＬ）调节２功能的紊乱在鼻息肉发病中的重要作用。方法 应用免疫组织化学的方法检测３２例鼻息肉标本和６例下鼻甲粘膜对照标本中Ｔ－细胞亚群（ＣＤ＾＋４和ＣＤ＾＋８细胞）以及细胞因子ＩＬ－５、ＩＬ－１０阳性细胞的表达情况。并进行统计学分析。结果 鼻息肉组织中可见各种炎细胞浸润,ＣＤ＾＋４和ＣＤ＾＋８细胞数增多（Ｐ〈０．００１）;其中ＣＤ     

慢性扁桃体炎患者外周血T淋巴细胞亚群的分析与临床意义

目的：探讨慢性扁桃体炎患者外周血T淋巴细胞各亚群的变化特点及其与肾损害的关系。方法：采用流式细胞仪检测54例慢性扁桃体炎患者和52例健康体检者的外周血初始T细胞、功能T细胞、激活T细胞及凋亡T细胞亚群百分比,并结合血清半胱氨酸蛋白酶抑制剂（CystatinC）、ASO和ESR水平进行统计学分析。结果：慢性扁桃体炎患者外周血CD3^＋T细胞、CD3^＋CD8^＋T细胞、CD4^＋CD28^＋T细胞、CD8^＋CD28^＋T细胞、CD4^＋HLA—DR^＋T细胞、CD8^＋HLA—DR^＋T细胞、CD8^＋CD95^＋T细胞与健康对照组相应细胞亚群之间的差异无统计学意义（P〉0．05）。但CD4^＋T细胞、CD4^＋CD45RA^＋T细胞和CD4^＋CD25^＋T细胞减少,CD4^＋CD45RO^＋T细胞、CD8^＋CD38^＋T细胞和CD4^＋CD95^＋T细胞增加,CD4^＋／CD8^＋和CD4^＋CD45RA^＋／CD4^＋CD45RO^＋比值下降,与健康对照组相应细胞亚群之间的差异有统计学意义（P〈0．05）。慢性扁桃体炎患者的外周血CD4^＋CD45RA^＋T细胞百分比与其血清Cystatin C浓度负相关。结论：本研究通过对外周血各T细胞亚群变化特点的系统研究,证实了慢性扁桃体炎患者机体存在T细胞免疫平衡紊乱。CD4^＋CD45RA^＋T细胞的变化可以作为慢性扁桃体炎患者肾损害的相关参考指标。     

Administration of the immunomodulator gepon after tonsillectomy

The study included 37 patients with chronic tonsillitis. Before and after tonsillectomy all the patients' humoral and cellular immunities were studied. Local thermometry and physiological test "pharynx" were made. For optimization of early postoperative period, all the tonsillectomized patients were given a domestic immunomodulator with local anti-inflammatory activity gepon. The results of gepon therapy allowed conclusion that local use of immunomodulator gepon early after bilateral tonsillectomy is justified and can be recommended for wide clinical practice.     

Surgical outcomes and unique histological features of tonsils after tonsillectomy in adults with periodic fever,aphthous stomatitis,pharyngitis, and cervical adenitis syndrome

ObjectivesData on the adult-onset periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome are scarce. European studies reported that unlike pediatric-onset PFAPA, tonsillectomy is ineffective for adult-onset PFAPA. The aims of this study were (1) to assess the response to tonsillectomy in a cohort of Japanese adult-onset PFAPA patients and (2) to evaluate the histologic appearance of tonsils in adult-onset PFAPA patients and to compare them with those of tonsils from age- and sex-matched controls with chronic tonsillitis.MethodsIn this retrospective cohort study, 5 adults with PFAPA and 15 controls who had undergone tonsillectomy were recruited. The size of the tonsil germinal centers was measured by hematoxylin and eosin staining, and the number and density of B and T lymphocytes in germinal centers were measured by immunohistochemistry, using CD3, CD4 and CD8 as T cell markers and CD20 as B cell marker.ResultsAll patients had complete remission of the symptoms after surgery. PFAPA patients had significantly smaller germinal center areas than controls. The number and density of CD8+ cells in germinal centers were significantly lower in tonsils from PFAPA compared with controls. No differences were found between the two groups in CD3+, CD4+, and CD20+ cells. These results are compatible with the tonsillar features of pediatric-onset PFAPA.ConclusionOur report demonstrates that tonsillectomy might be effective for adult-onset PFAPA and that tonsils of adult- and pediatric-onset PFAPA share the same histological features. These results suggest that the pathogenic mechanisms of adult- and pediatric-onset PFAPA are identical.     

Long term outcome of tonsillar regrowth after partial tonsillectomy in children with obstructive sleep apnea

Objective

We investigated the long-term effects of partial tonsillectomy, and potential risk factors for tonsillar regrowth in children with obstructive sleep apnea hypopnea syndrome (OSAHS).

Methods

Children affected by OSAHS with obstructive hypertrophic tonsils underwent partial tonsillectomy or total tonsillectomy with radiofrequency coblation. Polysomnography was performed prior to and 5 years following surgery. Blood samples from all participants were taken prior to and 1 month following surgery to assess immune function. All participants were interviewed 5 years following surgery to ascertain effects of the surgery, rate of tonsillar regrowth, and potential risk factors.

Results

All parents reported alleviation of breathing obstruction. Postoperative hemorrhage did not occur in the partial tonsillectomy group compared to 3.76% in the total tonsillectomy group. Tonsillar regrowth occurred in 6.1% (5/82) in children following partial tonsillectomy. Palatine tonsil regrowth occurred a mean of 30.2 months following surgery, and 80% of children with tonsillar regrowth were younger than 5 years of age. All five patients had a recurrence of acute tonsillitis prior to enlargement of the tonsils. Four of the five had an upper respiratory tract allergy prior to regrowth of palatine tonsils. There were no differences in IgG, IgM, IgA, C3, or C4 levels following partial tonsillectomy or total tonsillectomy.

Conclusion

Partial tonsillectomy is sufficient to relieve obstruction while maintaining immunological function. This procedure has several post-operative advantages. Palatine tonsils infrequently regrow. Risk factors include young age, upper respiratory tract infections, history of allergy, and history of acute tonsillitis prior to regrowth.     

Effect of chewing gum on recovery after tonsillectomy

OBJECTIVE: Patients are traditionally advised to eat early and frequently in the initial post-tonsillectomy period to reduce the severity of pain and to facilitate early resumption to a normal diet. We investigated the action of mastication and therefore the promotion of saliva formation and deglutition on the post-operative recovery of tonsillectomy patients. METHODS: We present a prospective randomised controlled trial set up to observe the effects of chewing gum on these patients. One hundred and two patients undergoing routine tonsillectomy for recurrent tonsillitis were randomised into cases (those given chewing-gum) and control groups (those not given chewing-gum). Eighty-four patients were reviewed on the seventh post-operative day. We measured the time taken in days for the subjects to resume to their normal diet after surgery and measured pain on a daily basis. RESULTS: Our study demonstrated that chewing gum in the early post-operative period significantly delayed resumption of normal diet (Chi-squared test with Yates' correction, chi2= 4.6, P = 0.032). Chewing gum also increased the average amount of pain experienced by the cases over the controls and this became statistically significant on day 7 (mean difference = 14.8, t-test with two tailed probability, P = 0.041). CONCLUSION: We conclude that chewing gum should not be routinely advised in the early period following tonsillectomy.     

Comparison of three techniques in adult tonsillectomy

This study aimed at investigating the thermal welding (TW), classic dissection (CD) and bipolar cautery dissection (BCD) tonsillectomy in adults. 120 adults with chronic tonsillitis, who were scheduled for elective tonsillectomy between January 2009 and April 2012, were randomized to tonsillectomy with the TW, CD and BCD methods. Operation time, intraoperative blood loss, post-operative haemorrhage rate and especially post-operative pain were evaluated. The difference between operative time of the TW and BCD groups against CD group was statistically significant (p < 0.05). The difference between intraoperative blood loss of the TW and BCD groups against CD group was statistically significant (p < 0.05). No significant difference was found in the incidence of post-tonsillectomy haemorrhage between the three groups (p > 0.05). The difference between post-operative pain score between CD and TW was not statistically significant (p > 0.05). The difference between post-operative pain score of the two groups against BCD group was statistically significant (p < 0.05). TW technique is a relatively safe and reliable method with significantly less post-operative morbidity than CD and BCD tonsillectomy. When we compared TW with the CD and BCD tonsillectomy, we found significant reduction in the surgical time and the intraoperative blood loss without any increase in the post-operative pain.     

变应性鼻炎患者血清CD23和CD19表达及其与血清总IgE的关系

目的：探讨变应性鼻炎（AR）患者外周血淋巴细胞CD23、CD19表达及其与血清总IgE、鼻部过敏症状的关系。方法：对46例AR患者进行症状评分后,采用流式细胞术及免疫化学发光法检测其外周血淋巴细胞CD23、CD19表达率和血清总IgE水平,并以32例健康体检者为对照。结果：①AR患者外周血CD23^＋、CD19^＋及CD23^＋／CD19^＋淋巴细胞百分率（^-x±s）分别为11.6±1.9、22.8土3.3和10.2±1.7,分别高于对照组（P〈0.05）。②CD23^＋、CD19^＋、CD23^＋／CD19^＋表达百分率与血清总IgE水平、AR症状评分之间存在正相关。③三者之中以CD23^＋／CD19^＋表达百分率与血清总IgE水平、AR症状评分相关性最强（r值分别为0.65和0.49,P〈0.05）。④CD23^＋／CD19^＋与AR症状评分相关程度优于血清总IgE对应值（r=0.33,P〈0.05）。结论：外周血淋巴细胞CD23、CD19表达参与AR发病,并可能是血清总IgE水平的影响因素,检测CD23^＋／CD19^＋表达率有助于对AR病情的判断。     

Implication of immunological abnormalities after adenotonsillotomy

The adenoids and tonsils are thought to be essential parts of the system protecting organism against pathogens invading the upper respiratory tracts. Human adenoids and tonsils are known to be immunologically reactive lymphoid organs, which manifest specific antibodies and B and T cells activity in response to variety of antigens carrying out the functions of humoral and cellular immunity. The purpose of the study was to observe the changes in systemic immunity in children with hypertrophy of adenoids and tonsils treated in Department of Laryngology, Children's Hospital in Warsaw in period 1994-1999. The study comprised 80 patients (33 girls and 47 boys, aged from 3 to 14 years, mean age 6.8 years) with diagnosed hypertrophy of adenoids and tonsils. The diagnosis of hypertrophy of adenoids and tonsils was based on characteristic history and laryngological examination. All patients were scheduled for adenotonsillotomy. The control group comprised 40 people (14 girls and 26 boys, aged from 3 to 15 years, mean age 7.6 years) without history of the recurrent upper tract infections. In all patients we carried out following examinations: serum levels of immunoglobulins A, G, M (humoral immunity); percentage of T lymphocytes (CD3); percentage of T helper (CD4) and T cytotoxic (CD8) lymphocytes (cellular immunity) and delayed cutaneous hypersensitivity-Multitest CMI (cell mediated immunity). Our study demonstrate that in children with hypertrophy of adenoids and tonsils exist changes in the immunological parameters. The observed changes appear not only locally but also generally. In the early period after adenotonsillotomy there was statistically significant decrease of the values of humoral and cellular immunity parameters. However, 6 months after operation we observed normalization of examined immunological parameters. We think that the examinations of parameters of immunological system (humoral and cellular) are necessary before planned adenotonsillotomy.     

The natural history of recurrent acute tonsillitis and a clinical trial of azithromycin for antibiotic prophylaxis

The pharmacokinetics of azithromycin (Zitromax), Pfizer Inc., USA) in tonsil tissue warranted the present trial. In 110 patients eligible for tonsillectomy because of recurrent acute tonsillitis, surgery was replaced by randomized medication with azithromycin 500 mg or placebo once per week for 6 months. Subsequently, their clinical condition and microbiology was monitored for 12 months. Acute tonsillitis developed in 40% of the patients who received azithromycin and in 49% of the patients in the placebo group (P > 0.05). Accordingly, 45% of all patients developed acute tonsillitis. Resistance to azithromycin was not detected. In this trial long-term medication with azithromycin was not efficacious in recurrent acute tonsillitis. As all patients were eligible for tonsillectomy according to current criteria, it is surprising that only 45% developed acute tonsillitis during the trial period. Therefore, the criteria for tonsillectomy in recurrent acute tonsillitis must be revised.     

The effect of fusafungine on post-operative pain and wound healing after pediatric tonsillectomy

OBJECTIVE: To investigate the effect of fusafungine spray on pain and healing process after pediatric tonsillectomy. METHODS: Sixty children with ages between 4 and 14 years underwent tonsillectomy or adenotonsillectomy. The patients were randomly divided into three groups and each group consisted of 20 patients. Group 1 was treated with antibiotic (amoxicillin-clavulanic acid) plus analgesic (acetaminophen), group 2 was treated with fusafungine plus analgesic (acetaminophen) and group 3 was treated with only fusafungine. The average ages were 7.8 + 3.4, 6.6 + 2.9, and 8.2 + 3.7 for groups 1, 2, and 3, respectively. Clinical evaluations were made after the operation on the 1st (T1), 3rd (T3), 7th (T7), 10th (T10), and 14th days (T14). RESULTS: There was no significant difference in post-operative pain between study groups on the post-operative 1st, 3rd, and 7th days (P > 0.05), a statistically significant difference was present between groups 1 and 3, and groups 1 and 2 on the post-operative 10th and 14th day (P = 0.018 and 0.037, respectively). Pain was less in groups 2 and 3 than in group 1 on the 10th and 14th day. Also there was a significant difference in healing time of the tonsillary beds between groups 1 and 2, and groups 1 and 3 on the 10th and 14th post-operative day (P = 0.031 and 0.001, respectively). Healing was better in groups 2 and 3 than in group 1 on the 10th and 14th day. CONCLUSION: Fusafungine administration after tonsillectomy was found to be beneficial on post-operative pain and wound healing of tonsillary beds in pediatric population.     

Tonsillectomy and the immune system: a long-term follow up comparison between tonsillectomized and non-tonsillectomized children

Immunological functions of the tonsils and possible effects of their removal are still controversial. One reason for this is the lack of long-term follow-up investigations after tonsillectomy. In the present study selected parameters of the cellular and Immoral immune systems of 160 children 0.5–11 years after tonsillectomy (mean 6.6 ± 2.1 years) were compared to those of 302 age-matched non-tonsillectomized children. In tonsillectomized children the incidence of infections of the upper respiratory tract was not increased compared to the non-tonsillectomized control group. Slightly increased percentages of CD 21+ cells, raised counts of CD4+ cells, absolute and relative increases in DR+ cells and a raised CD4+ DR count was found mainly in tonsillectomized boys, while lymphocyte subpopulations of tonsillectomized girls remained unaffected. Tonsillectomized children had lower IgA levels, but the complement system was not altered in either sex. These findings show that while tonsillectomy may lead to certain changes in the cellular and humoral immune systems, these alterations are clinically insignificant and no increased frequency of immunomodulated diseases should be expected.     

Efficacy of tonsillectomy on psoriasis and tonsil histology]

Treatment outcomes of tonsillectomy were studied in 7 Japanese patients with psoriasis--3 males and 4 females aged 9 to 46 years (median: 23 years)--followed up 2 to 9 years after tonsillectomy. All skin lesions disappeared in 3 patients, 80% of those in 2, and no change in the remaining 2 during follow-up. Of 5 in whom skin lesions improved, 4 were females and had a history of tonsillitis making skin lesions worse. In quantitative immunohistologic analysis on tonsillar tissues by CD20 and anti-ssDNA antibodies, areas of T cell-nodules were significantly expanded, but those of the B-lymphoid follicles were smaller, and the number of apoptotic cells increased in tonsils from patients with psoriasis and PPP compared to those with recurrent tonsillitis. The area of T cell-nodules and the number of apoptosis cells were significantly larger in tonsils from 4 patients with complete recovery after tonsillectomy compared to the remaining 9 without complete recovery. This suggests that histologic evaluation may be helpful in estimating the effectiveness of tonsillectomy.     

Investigation of oxidative stress in patients with chronic tonsillitis

Objectives

Oxidative stress has been implicated in numerous pathological conditions including chronic tonsillitis. The aim of this study was to assess levels of lipid peroxidation, evidenced by formation of thiobarbituric acid reactive substance (TBARS), level of total sulfhydryl groups (TSH), and carbonyl content in patients with tonsillar hypertrophy (TH) and recurrent tonsillitis (RT), before and after tonsillectomy.

Methods

In this study the serum and tonsillar tissue levels of TBARS, TSH and carbonyl content were investigated in 35 patients with TH and RT, before and 1 month after the operation, compared to 30 age-matched controls.

Results

In both TH and RT groups, a significantly higher serum TBARS levels were observed before and 4 weeks after tonsillectomy in comparison with healthy subjects. The serum level in TH patients after operation was even higher compared to the levels before. There was statistically significant difference in serum TSH levels between patients with RT before operation compared to the control group. After tonsillectomy the serum levels of TSH were higher compared to control groups and TH and RT patients before operation. Carbonyl content was attenuated only in TH patients after tonsillectomy. In tonsillar tissue, significantly lower level of glutathione content (GSH) has been observed in RT related to TH patients.

Conclusions

Oxidative stress, in patients with tonsillar hypertrophy and recurrent tonsillitis, is still present 1 month after the removal of tonsillar tissue. Antioxidant therapy, during the recovery period after tonsillectomy, could be optional treatment.     

腺样体切除加扁桃体单纯消融或扁桃体部分切除加消融对OSAHS患儿术后免疫功能的影响

目的:探讨等离子辅助下治疗儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS),腺样体切除加扁桃体单纯消融或扁桃体部分切除加消融对儿童术后免疫功能的影响.方法:对70例OSAHS患儿采用低温等离子消融术切除腺样体,同时根据扁桃体的大小采用扁桃体单纯消融(扁桃体单纯消融组)或扁桃体部分切除加消融(扁桃体部分切除加消融组),分...     

Is immune system influenced by adenotonsillectomy in children?

OBJECTIVE: Tonsils and adenoids are lymphoid tissues that are located in the pharynx and play an important role against invading antigens of the upper respiratory tract. The present study analyses serum immunoglobulin levels and peripheral blood (PB) lymphocyte subsets in children, 24-48 h prior to and 4-6 weeks after adenotonsillectomy, in order to determine early effects of adenotonsillectomy on the immune system. METHODS: The study population consists of 15 children (aged 4-10 years) who underwent adenotonsillectomy because of adenoidal hypertrophy and chronic tonsillitis and 15 age-matched healthy children without a history of adenotonsillectomy. Serum IgG, IgA and IgM levels were measured by nephelometry. PB lymphocyte subsets were analysed by using monoclonal antibodies and flow cytometry. RESULTS: Children with chronic tonsillitis have increased levels of CD19+ B lymphocytes compared to healthy controls in the pre-operative period. The percentage of B lymphocytes bearing CD23 was found to be significantly higher in patients, most likely representing in vivo B lymphocyte activation due to chronic antigenic stimulation. After the adenotonsillectomy, despite ongoing B lymphocyte activation, CD8+ T lymphocyte levels increased and B cell levels returned to normal. A slight decrease in serum IgG, IgA and IgM levels was detected in the post-operative period compared to prior levels. CONCLUSION: Adenotonsillectomy performed in children leads to alterations that may reflect a compensatory response of the developing immune system after the removal of the lymphoid tissue in the setting of chronic antigenic stimulation. However, these changes do not cause significant immune deficiency.     

CD45RO CD20及总IgE在声带息肉组织中表达的研究

目的 :从免疫病理学角度探讨细胞免疫、体液免疫和局部变态反应在声带息肉发病中的作用。方法 :对 30例声带息肉组织 (息肉组 )和 10例正常声带组织 (对照组 )采用免疫组织化学方法观察两组CD4 5RO、CD2 0及IgE的表达情况并检测其阳性细胞数。 结果 :息肉组CD4 5RO、CD2 0和IgE阳性细胞数显著高于对照组 (P <0 .0 1) ;声带息肉组织中CD4 5RO、CD2 0和IgE的表达之间无相关性 ;男、女患者间的表达差异亦无统计学意义 (P >0 .0 5 )。 结论 :由T淋巴细胞介导的细胞免疫和B淋巴细胞介导的体液免疫在声带息肉中免疫应答活跃 ;声带黏膜局部变态反应参与了声带息肉的发病 ;在声带息肉的发病机制中免疫病理改变起着重要的作用。     

Bipolar scissors versus cold dissection for pediatric tonsillectomy--a prospective,randomized pilot study

OBJECTIVE: To evaluate bipolar scissors tonsillectomy by comparing it with traditional cold dissection tonsillectomy. The outcome measures used were: (1) intra-operative bleeding; (2) operative time; (3) post-operative pain; and (4) complication rates including reactionary and secondary hemorrhage. METHOD: A prospective, randomized multiunit study involving three teaching hospitals in Belfast. Fifty consecutive children aged 10-16 years undergoing tonsillectomy for recurrent or chronic tonsillitis, between March 2000 and September 2000 were recruited as a subgroup of 200 patients selected for this study. These children were analysed separately from the adults, in a pilot study for the above parameters. RESULTS: The mean age of the study population was 14.3 years. Sixty-eight percent of the children were girls. Median intra-operative blood loss was 6 ml for bipolar scissors tonsillectomy and 86 ml for cold dissection tonsillectomy (P<0.001). The median operative time was 10.5 min for bipolar scissors tonsillectomy compared to 14.5 min for the cold dissection method (P=0.001). There was no statistically significant difference in the pain scores between the two methods (P>0.05). The overall reactionary hemorrhage rate was 4% while the overall secondary hemorrhage rate was 14%. The hospital readmission rate was 4%. The reactionary and secondary hemorrhage rates were unaffected by the surgical method. CONCLUSIONS: This pilot study has shown that bipolar scissors tonsillectomy is a relatively safe technique in children aged 10-16 years with a similar morbidity to the cold dissection method. Its use is associated with a significant decrease in surgical time and blood loss compared to the cold dissection method. These advantages make it a favourable instrument for pediatric tonsillectomy especially in this age group.