儿童阻塞性睡眠呼吸暂停低通气综合征与鼻部疾病关系的初步研究

Relationship between children＇ s obstructive sleep apnea hypopnea syndrome and nasal diseases

目的探讨儿童阻塞性睡眠呼吸暂停低通气综合征（obstructivesleepapneahypopneasyndrome，OSAHS）与鼻部疾病的关系。方法选择2008年6月至2010年10月期间，在门诊和病房以多道睡眠图（polysomnography，PSG）检查确诊的338例OSAHS患儿为病例组，并根据阻塞性呼吸暂停指数（obstructiveapneaindex，OAI）或呼吸暂停低通气指数（apneahypoventilationindex，AHI）分为轻、中、重3个亚组，同时采用简单随机抽样方法，选择同期就诊的无上呼吸道阻塞症状的207例声带小结患儿为对照组。对两组患儿每年上呼吸道感染次数以及血清总IgE（totalIgE，tIgE）、特异性IgE（specificIgE，sIgE）、电子鼻咽喉镜和鼻窦CT的检查结果进行回顾性分析，探讨儿童OSAHS与鼻部疾病的相关性。以SPSS17．0软件对数据进行统计学分析。结果病例组每年上呼吸道感染次数、血清tIgE阳性比例、鼻一鼻窦炎、鼻腔狭窄的比例分别为（8．7±5．7）次、60．9％、79．9％、50．0％，均明显高于对照组的（4．4±2．6）次、32．8％、12．1％、6．3％，差异有统计学意义（t=7．578，）χ2值分别为41．943、237．704、110．322，P值均〈0．01）。多因素回归分析显示，鼻腔狭窄、鼻-鼻窦炎为儿童OSAHS的主要危险因素（OR值分别为16．008、4．671，P值均〈0．01），二者对儿童OSAHS存在联合作用（OR=113．430，P〈0．01）。鼻-鼻窦炎、鼻腔狭窄在病例组轻、中、重3个亚组中呈逐渐增加趋势（χ2值分别为21．571、17．304，P值均〈0．01）。结论上呼吸道感染和变态反应因素为儿童OSAHS的危险因素。鼻-鼻窦炎、鼻腔狭窄为儿童OSAHS的主要危险因素，并与OSAHS病情严重程度呈正相关。

Objective To explore the relationship between children obstructive sleep apnea hypopnea syndrome （OSAHS） and nasal diseases. Methods Three hundred and thirty-eight cases of pediatric OSAHS confirmed by polysomnography （PSG） had been enrolled as the treatment group, and divided into mild subgroup, moderate subgroup and severe subgroup according to the obstructive apnea index （OAI） and apnea hypoventilation index （AH]）. The other two hundred and seven pediatric vocal cord nodule cases without OSAHS had been randomly selected as the control group. The retrospective analysis of upper respiratory tract infection frequency per year, expression levels of total IgE （tIgE） and allergen- specific IgE （sIgE）, results of electronic nasophal^ngoscope test and nasal sinus CT scans had been performed in all the pediatric cases. The data were analyzed by SPSS 17.0. Results The upper respiratory tract infection frequency per year, ratio of cases with positive results of tIgE, ratio of cases with nasosinusitis, ratio of cases with narrow nasal cavity in the experiment group were respectively 8.7 ± 5.7, 60. 9% , 79.9% and 50. 0% , while those in the control group were respectively 4.4± 2. 6, 32. 8% , 12. 1% and 6. 3% , with significant difference between groups （t = 7. 578,χ2 value was 41. 943, 237. 704, 110. 322, all P 〈 0. 01 ）. The multiple regression analysis indicated that, nasosinusitis and narrow nasal cavity were the two major risk factors of pediatric OSAHS （ OR1 = 16. 008, OR2 = 4. 671, all P 〈 0. 01 ）, with combined effects（ OR--113. 430,P 〈0. 01 ）. The rank test analysis in term of risk factors of severity of OSAHS had indicated that, prevalence of nasosinusitis and narrow nasal cavity were increased as risingseverity of OSAHS （χ1^2 =21.571, χ2^2 = 17.304, all P〈0.01）. Conclusions Infection and allergy are risk factors of pediatric OSAHS. Nasosinusitis and narrow nasal cavity are two major risk factors of pediatric OSAHS, which have positive relationship with the severity of OSAHS.