不同手术方式治疗学龄前儿童OSAHS术前及术后免疫功能的比较
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摘要
目的通过对两组不同手术方式的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿术前及术后免疫功能的比较,探讨OSAHS患儿最适合的手术方式,以最大限度地改善患儿的生活质量而不影响患儿的免疫功能。方法选取3～6岁患儿120例,行多导睡眠监测(PSG)诊断为OSAHS,随机分为腭咽成形术组与扁桃体部分切除术组,测定所有入选患儿术前、术后1月、术后3个月的血清免疫球蛋白IgA、IgG、IgM,补体C3、C4水平,T淋巴细胞亚群CD3~+、CD4~+、CD8~+T淋巴细胞百分率及CD4~+/CD8~+比值、NK值,同时设立空白对照组,监测相同的指标,将2个试验组患儿术前、术后1个月及术后3个月的数据与对照组的数据分别进行统计学分析。结果术后1个月时,扁桃体部分切除术组与腭咽成形术组的患儿IgA、IgG、IgM及补体C3、C4均较术前1d下降,但差异无统计学意义(P>0.05),术后3个月时接近术前水平。扁桃体部分切除术组与腭咽成形术组比较,术后1个月时,腭咽成形术组CD3~+T淋巴细胞、CD4~+T淋巴细胞、NK细胞百分率及CD4~+/CD8~+比值明显低于对照组与扁桃体部分切除术组,且差异均有统计学意义(P<0.05);术后3个月时,腭咽成形术组CD3~+T淋巴细胞、CD4~+T淋巴细胞、NK细胞百分率及CD4~+/CD8~+比值低于对照组与扁桃体部分切除术组,但差异均无统计学意义(P>0.05)。结论腭咽成形术组与扁桃体部分切除术治疗OSAHS患儿,患儿术后体液免疫及细胞免疫功能和术前相比略有下降,但3个月内基本恢复正常;腭咽成形术与扁桃体部分切除术对患儿同期免疫功能的影响无明显差异。
Objective To explore the most suitable surgical modes for children with obstructive sleep apnea hypopnea syndrome(OSAHS)by comparing the preoperative and postoperative immune function of OSAHS children treated by different surgical methods in order to maximize to improve their life quality without affecting their immunity.Methods A total of 120 children aged 3-6 years old were selected.OSAHS was diagnosed by polysomnography(PSG).They were randomly divided into the velopharyngeal angioplasty group and partial tonsillectomy group.Serum immunoglobulin IgA,IgG,IgM,complement C3,C4 levels and T lymphocyte subsets CD3~+,CD4~+,CD8~+,CD4~+/CD8~+ ratio and NK value were measured before operation and at postoperative one and three months.Meanwhile the blank control group was established.The same indexes were monitored.The data before operation and at postoperative one and three months in the two experimental groups were statistically analyzed.Results At postoperative one month,the levels of IgA,IgG,IgM,complement C3 and C4 in the two experimental groups were decreased compared with those on preoperative one d,but the difference was not statistically significant(P>0.05),which at postoperative three months were closed to the preoperative levels.In the comparison between the partial tonsillectomy group and velopharyngeal angioplasty group,the percentages of CD3~+T lymphocytes and CD4~+T lymphocytes and NK cells,and ratio of CD4~+/CD8~+ in the velopharyngeal formation group were significantly lower than those in the partial tonsillectomy group,and the difference was statistically significant(P<0.05);postoperative 3 months,the percentages of CD3~+T lymphocytes,CD4~+T lymphocytes,NK cells and CD4~+/CD8~+ratio in the velopharyngeal formation group were lower than those in the partial tonsillectomy group,but the difference was not statistically significant(P>0.05).Conclusion In OSAHS children patients treated by velopharyngeal angioplasty and partial tonsillectomy,the postoperative humoral immunity and cellular immune function are slightly decreased compared with those before surgery,but which basically returns to normal within 3 months.The effects of velopharyngeal angioplasty and partial tonsillectomy on their immune function in the corresponding period have no significant difference.
Objective To explore the most suitable surgical modes for children with obstructive sleep apnea hypopnea syndrome(OSAHS)by comparing the preoperative and postoperative immune function of OSAHS children treated by different surgical methods in order to maximize to improve their life quality without affecting their immunity.Methods A total of 120 children aged 3-6 years old were selected.OSAHS was diagnosed by polysomnography(PSG).They were randomly divided into the velopharyngeal angioplasty group and partial tonsillectomy group.Serum immunoglobulin IgA,IgG,IgM,complement C3,C4 levels and T lymphocyte subsets CD3~+,CD4~+,CD8~+,CD4~+/CD8~+ ratio and NK value were measured before operation and at postoperative one and three months.Meanwhile the blank control group was established.The same indexes were monitored.The data before operation and at postoperative one and three months in the two experimental groups were statistically analyzed.Results At postoperative one month,the levels of IgA,IgG,IgM,complement C3 and C4 in the two experimental groups were decreased compared with those on preoperative one d,but the difference was not statistically significant(P>0.05),which at postoperative three months were closed to the preoperative levels.In the comparison between the partial tonsillectomy group and velopharyngeal angioplasty group,the percentages of CD3~+T lymphocytes and CD4~+T lymphocytes and NK cells,and ratio of CD4~+/CD8~+ in the velopharyngeal formation group were significantly lower than those in the partial tonsillectomy group,and the difference was statistically significant(P<0.05);postoperative 3 months,the percentages of CD3~+T lymphocytes,CD4~+T lymphocytes,NK cells and CD4~+/CD8~+ratio in the velopharyngeal formation group were lower than those in the partial tonsillectomy group,but the difference was not statistically significant(P>0.05).Conclusion In OSAHS children patients treated by velopharyngeal angioplasty and partial tonsillectomy,the postoperative humoral immunity and cellular immune function are slightly decreased compared with those before surgery,but which basically returns to normal within 3 months.The effects of velopharyngeal angioplasty and partial tonsillectomy on their immune function in the corresponding period have no significant difference.
引文
[1]中华耳鼻咽喉头颈外科杂志编委会.中华医学会耳鼻咽喉科学分会.儿童阻塞性睡眠呼吸暂停低通气综合征诊疗指南草案(乌鲁木齐)[J].中华耳鼻咽喉头颈外科杂志,2007,42(2):83-84.
[2]GORMAN D,OGSTON S,HUSSAIN S.Improvement in symptoms of obstructive sleep apnoea in children following tonsillectomy versus tonsillotomy:a systematic review and meta-analysis[J].Clin Otolaryngol,2017,42(2):275-282.
[3]张峰,姚红兵,李兵.儿童阻塞性睡眠呼吸暂停低通气综合征与认知障碍[J].国际耳鼻咽喉头颈外科杂志,2012,36(5):284-287.
[4]ZHANG F,TIAN Z,PENG S,et al.Exposure to intermittent hypoxia impairs learning and memory ability in rats[J].Sleep Biol Rhythms,2018,16(3):331-336.
[5]佘吉佳,周雪敏,伍昌林.免疫调节性细胞及其效应分子在CITP免疫功能紊乱中的作用研究[J].检验医学与临床,2016,13(20):2874-2876.
[6]殷明德.小儿扁桃体和腺样体切除术适应证的免疫学基础[J].临床耳鼻咽喉头颈外科杂志,2010,24(9):385-385.
[7]陈芳,李晓艳.扁桃体腺样体切除对儿童阻塞性睡眠呼吸暂停低通气综合征术后免疫功能的影响[J].临床耳鼻咽喉头颈外科杂志,2012,26(7):333-336.
[8]NASRIN M,MIAH M R,DATTA P G,et al.Effect of tonsillectomy on humoral immunity[J].BaIlgladesh Med Res CouIlc Bull,2012,38(2):59-61.
[9]SANTOS F B.Short and long term impact of adenotonsillectomy on the immune system[J].Braz J Otolarhinolaryngol,2013,79(1):28-34.
[10]ACEVEDO J L,SHAH R K,BRIETZKE S E.Systematic review of complications of tonsillotomy versus tonsillectomy[J].Otolaryngol Head Neck Surg,2012,146(6):871-879.
[11]孙余才.学龄前儿童扁桃体和腺样体切除后对机体免疫功能影响的研究[J].中国基层医药,2017,24(6):937-939.
[12]周成勇,代志瑶.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[J].临床耳鼻咽喉头颈外科杂志,2011,25(21):990-992.
[13]韦善文,孟立新,谭柳春,等.扁桃体部分切除术治疗儿童阻塞性睡眠呼吸暂停综合征的临床分析[J].广西医科大学学报,2014,31(4):695-696.
[2]GORMAN D,OGSTON S,HUSSAIN S.Improvement in symptoms of obstructive sleep apnoea in children following tonsillectomy versus tonsillotomy:a systematic review and meta-analysis[J].Clin Otolaryngol,2017,42(2):275-282.
[3]张峰,姚红兵,李兵.儿童阻塞性睡眠呼吸暂停低通气综合征与认知障碍[J].国际耳鼻咽喉头颈外科杂志,2012,36(5):284-287.
[4]ZHANG F,TIAN Z,PENG S,et al.Exposure to intermittent hypoxia impairs learning and memory ability in rats[J].Sleep Biol Rhythms,2018,16(3):331-336.
[5]佘吉佳,周雪敏,伍昌林.免疫调节性细胞及其效应分子在CITP免疫功能紊乱中的作用研究[J].检验医学与临床,2016,13(20):2874-2876.
[6]殷明德.小儿扁桃体和腺样体切除术适应证的免疫学基础[J].临床耳鼻咽喉头颈外科杂志,2010,24(9):385-385.
[7]陈芳,李晓艳.扁桃体腺样体切除对儿童阻塞性睡眠呼吸暂停低通气综合征术后免疫功能的影响[J].临床耳鼻咽喉头颈外科杂志,2012,26(7):333-336.
[8]NASRIN M,MIAH M R,DATTA P G,et al.Effect of tonsillectomy on humoral immunity[J].BaIlgladesh Med Res CouIlc Bull,2012,38(2):59-61.
[9]SANTOS F B.Short and long term impact of adenotonsillectomy on the immune system[J].Braz J Otolarhinolaryngol,2013,79(1):28-34.
[10]ACEVEDO J L,SHAH R K,BRIETZKE S E.Systematic review of complications of tonsillotomy versus tonsillectomy[J].Otolaryngol Head Neck Surg,2012,146(6):871-879.
[11]孙余才.学龄前儿童扁桃体和腺样体切除后对机体免疫功能影响的研究[J].中国基层医药,2017,24(6):937-939.
[12]周成勇,代志瑶.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[J].临床耳鼻咽喉头颈外科杂志,2011,25(21):990-992.
[13]韦善文,孟立新,谭柳春,等.扁桃体部分切除术治疗儿童阻塞性睡眠呼吸暂停综合征的临床分析[J].广西医科大学学报,2014,31(4):695-696.