儿童腺样体肥大合并变应性鼻炎对分泌性中耳炎发生率的影响

Incidence of Otitis Media with Effusion in Adenoid Hypertrophy with Allergic Rhinitis in Children

【目的】为了了解儿童腺样体肥大(AH)合并变应性鼻炎(AR)对分泌性中耳炎(OME)发生率的作用,并探讨AH儿童中OME发病的危险因素。【方法】收集2013年至2015年间我院205例住院行腺样体切除术或腺样体和扁桃体切除术的AH患儿的临床资料,包括病史和体征、声阻抗检查、变应原检查及血常规,评估AH患儿OME、AR的发病状况,并应用软件SPSS 20.0进行统计学分析。【结果】205例AH患儿中有66例(32.20%)合并OME,3~5岁年龄段AH患儿的OME发生率最高,随年龄增长,OME的发生率逐渐下降(P=0.018)。OME的发生率在AH是否合并AR两组间有统计学差异(P=0.010)。通过logistic回归分析发现Ⅲ度腺样体肥大、Ⅲ型腺样体形态的AH患儿发生OME的危险度分别增加2.729倍和6.390倍(P=0.047,P=0.001)。合并AR的AH患儿中发生OME的风险增加了1.212倍(P=0.010)。【结论】儿童AH并发OME是多因素共同作用的结果,机械阻塞因素与AR具有叠加作用,应该重视咽鼓管、中耳腔的"侧呼吸道"变应性炎症。

【Objective】In order to study the impact of adenoid hypertrophy（AH）with allergic rhinitis（AR）in the otitis media with effusion（OME）in children,as well as to discuss the risk factors on the inducement of OME in patients with AH.【Methods】The clinical materials were collected and analyzed from 205 children with AH who admitted for surgical treatment between 2013 and 2015,including medical history and signs,acoustic immittance measurement,allergy screen as well as blood routine,and to evaluate the situation of OME and AR in patients with AH. All the data were analyzed by SPSS 20.0.【Results】Among the 205 AH children,66cases（32.20%）were accompanying with OME. The AH patients aged 3-5 years had the highest incidence of OME,which decreased with age（P = 0.018）. It is significant on the prevalence of the OME in patients with AH between the two groups with and without AR（P = 0.010）. In the logistic model investigating the risk factors of inducing OME among patients with AH,the third-degree AH,Type-three and the accompanying with AR were significant. The third-degree and third-type AH children were 2.729 and 6.390-folds higher than others respectively（P = 0.047,P = 0.001）. The incidence of OME appeared to be 1.212- folds higher among patients with AR（P = 0.010）.【Conclusion】Mechanical obstruction and AR played a superimposed role in the inducement of OME among patients with AH,which was effected by multiple factors. We should pay attention to the＂lateral respiratory＂allergic diseases on eustachian tube and middle ear.