扁桃体腺样体切除对阻塞性睡眠呼吸暂停低通气综合征患儿免疫功能的影响

Influence of Tonsil Adenoidectomy on the Immune Function of Children with Obstructive Sleep Apnea Hypopnea Syndrome

目的观察扁桃体腺样体切除对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿免疫功能的影响。方法选择2010年5月至2013年2月在孝感市中心医院耳鼻喉科住院的52例OSAHS患儿行扁桃体腺样体切除术治疗,记录手术前、术后1个月、术后6个月多导睡眠监测结果(呼吸暂停指数、低通气指数、最长呼吸暂停时间、最长低通气时间及最低血氧饱和度)、血清免疫球蛋白(Ig A、Ig G、Ig M)水平及T淋巴细胞亚群(CD3、CD4、CD8)所占百分比变化。结果手术治疗6个月后患儿呼吸暂停指数、低通气指数、最长呼吸暂停时间、最长低通气时间较术前均显著降低[(1.7±0.6)次/h比(8.4±1.3)次/h,(5.0±1.7)次/h比(17.0±2.1)次/h,(24±5)s比(87±6)s,(30±9)s比(63±11)s,P<0.01],最低血氧饱和度较术前显著增高[(91±7)%比(74±13)%](P<0.05);患儿术后1个月Ig A、Ig G、Ig M等血清免疫球蛋白水平及CD4T淋巴细胞亚群所占百分比较术前显著降低[(1327±315)mg/L比(1635±407)mg/L,(8.8±1.6)g/L比(11.7±1.7)g/L,(1014±244)mg/L比(1270±379)mg/L,(35±4)%比(39±4)%,P<0.05],而术后6个月均恢复至术前水平,与术前比较差异无统计学意义(P>0.05)。结论扁桃体腺样体切除治疗OSAHS疗效显著,短期免疫指标有所下降,但长期免疫参数均可恢复至正常水平,对患儿免疫功能影响较小。

To observe the influence of tonsillectomy on the immune function of children with obstructive sleep apnea hypopnea syndrome（OSAHS）. Methods A total of 52 children with OSAHS treated in department of otolaryngology,Xiaogan Central Hospital from May 2010 to Feb. 2013 were treated with ton- sil adenoidectomy. The polysomnography （ apnea index, hypopnea index, the longest duration of apnea, hypop- nea longest time and lowest oxygen saturation）, serum immunoglobulin levels （IgA, IgG, IgM） and T lympho- cyte subgroup（ CD3 , CD4 , CDa ） percentage changes before surgery, 1 month after surgery and 6 months after surgery were recorded. Results The apnea index, low ventilation index, the longest time of apnea, longest low ventilation time 6 months after surgery significantly decreased than before surgery[ （ 1.7 ± 0.6 ） time/h vs （8.4 ±1.3） time/h,（5.0 ±1.7） time/h vs （17.0 ±2.1） time/h, （24 ±5） s vs （87 ±6） s,（30 ± 9） s vs（63 ± 11 ） s,P 〈0.01 ] ,and lowest oxygen saturation after treatment was improved significantly than before operation[ （91 ±7）% vs （74 ±13）% ] （P 〈0.05）. The IgA,IgG,lgM levels and percentage ofCD4 T lymphocyte subgroup at 1 month postoperative were significantly decreased than before operation [ （ 1327 ± 315） mg/Lvs （1635±407） mg/L,（8.8 ±1.6） g/Lvs （11.7 ±1.7） g/L,（1014 ±244） mg/Lvs （1270 ±379） rag/L, （35 ±4）% vs （39 ±4）% ,P 〈0.05] ,and the levels recovered to preoperative 6 months after surgery. Conclusion The treatment of tonsil adenoidectomy for OSAHS has a significant cura- tive effect,with short-term immune index decline, whieh return to normal in long-term perspective, thus has less effect on the immune function of children,