儿童阻塞性睡眠呼吸暂停相关血液学指标的临床研究

A clinical investigation of the hematological parameters related to obstructive sleep apnea in Children

目的 探讨阻塞性睡眠呼吸暂停(obstructive sleep apnea, OSA)儿童与健康儿童血液学指标的差异及不同严重程度和不同临床表型的OSA患儿血液学指标的变化情况,为儿童OSA的诊断及精准治疗提供理论支持。方法 纳入因睡眠打鼾就诊于耳鼻咽喉科确诊为OSA的76例患儿和37例对照组儿童。收集OSA儿童的病史及影像学检查及两组儿童的体格检查、睡眠呼吸监测结果、外周血指标:WBC、HB、ANC、ALC、PLT、MPV、PDW、RDW、NLR、PLR等。结果 OSA患儿的血液指标WBC、ANC、ALC、HB、NLR、PLR、PLT、MPV较正常儿童高,其中RDW存在较为差异显著统计学意义(P=0.001)。在OSA患儿不同严重程度亚组之间,WBC、ANC、ALC、NLR、RDW、PLT水平随OSA程度加重而升高,其中WBC、ANC、NLR差异有统计学意义(P<0.001;P<0.001;P=0.017)。腺样体显著肥大组患儿的WBC、ANC、NLR较病理肥大组、中度肥大组及正常组显著升高,其中ANC、NLR指标差异有统计学意义(P=0.014;P=0.015)。结论 外周血相关炎性指标可作为临床医师辅助检查、预测、评估儿童OSA病情严重程度的重要指标。WBC、ANC、NLR是临床上简便易得的指标,作为儿童OSA严重程度及机体炎症水平的潜在预测因子。

Objective This study investigated the differences in hematological parameters between children with and without obstructive sleep apnea(OSA),and the variations in hematological parameters among children with varying severity and clinical phenotypes of OSA.The research aimed to provide a theoretical framework for the diagnosis and precise treatment of pediatric OSA.Methods The study included 76 children diagnosed with OSA due to snoring and 37 children in the control group who visited the Otolaryngology department for consultation.Data,such as medical history,radiological examinations,physical examinations for both groups,sleep breathing monitoring results,and peripheral blood parameters including WBC,HB,ANC,ALC,PLT,MPV,PDW,RDW,NLR,and PLR,were analyzed.Results Children with OSA showed elevated hematological indices(WBC,ANC,ALC,HB,NLR,PLR,PLT,and MPV)compared to children without OSA.In particular,RDW exhibited a significant difference between the two groups(P=0.001).Subgroups of children with different OSA severity were evaluated and the results showed that the WBC,ANC,ALC,NLR,RDW,and PLT levels increased with increasing OSA severity.Moreover,WBC,ANC,and NLR were significantly different between the subgroups(P<0.001;P<0.001;P=0.017).Notably,children with significant adenoid hypertrophy displayed significantly higher WBC,ANC,and NLR levels compared to those with pathological hypertrophy,moderate hypertrophy,and the control group,with ANC and NLR showing statistical significance(P=0.014;P=0.015).Conclusion Peripheral blood inflammatory parameters can serve as essential indicators of OSA in the clinical setting.These parameters can assist clinical physicians in the examination,prediction,and evaluation of pediatric OSA and its severity OSA.Of the analyzed parameters,WBC,ANC,and NLR are readily available clinical indices,and thus,may be considered as potential predictive factors for the pediatric OSA and its severity,in addition to other systemic inflammatory levels.