腺样体扁桃体切除术与儿童过敏性鼻炎:一项纵向数据分析

Association between adenotonsillectomy and allergic rhinitis in children:A longitudinal database analysis

目的研究通过分析腺样体扁桃体切除术(AT)术后儿童过敏性鼻炎(AR)治疗变化情况来探究阻塞性睡眠呼吸暂停(OSA)对儿童AR的影响。方法纳入2015—2018年行AT的儿童AR患儿为手术组,收集首都儿科研究所附属儿童医院门急诊就诊信息,根据患儿门急诊就诊时段、年龄、性别采用倾向性得分匹配(PSM)按1∶2匹配为对照组,对两组术前一年或第一年、术后一年或第二年就诊次数、就诊费用及药物使用情况进行比较。主要结局包括就诊次数、就诊总费用、药物总费用、AR药物总费用及其改变。结果研究纳入(AT)手术组205例,对照组508例,手术组术前一年与对照组第一年相比,就诊次数差异无统计学意义(P=0.22);手术组总费用、药物总费用、AR药物费用高于对照组(P分别为<0.001、0.001、0.002)。手术组术后一年就诊次数减少28.3%(95%CI:25.2%~31.7%,P<0.001)。手术组术后一年就诊总费用减少37.5%(95%CI:37.3%~37.6%,P<0.001),药物总费用减少39.1%(95%CI:38.8%~39.3%,P<0.001),AR药物费用减少39.5%(95%CI:39.1%~39.8%,P<0.001)。结论AT可以减少儿童AR的就诊次数,降低治疗的就诊费用和药物费用。腺样体扁桃体肥大及OSA的监测和治疗可能有利于AR治疗策略的优化。

Objective This study aimed to explore the impact of obstructive sleep apnea(OSA)on Allergic rhinitis(AR)in children by analyzing the changes in AR treatment after adenotonsillectomy(AT).Methods The patients with AR who underwent AT from 2015 to 2018 were recruited as surgical group.According to the time of outpatient and emergency visits,age and gender,propensity score matching(PSM)was used to match the children at1:2 as the control group.The number of visits,medical costs and medication prescriptions were compared respectively between the two groups one year before and one year after surgery.Primary outcomes included number of visits,total cost of visits,total cost of medications,total cost of AR medicationsand itschange.Results This study included 205 patients in the surgical group(AT)and 508 patients in the control group.There was no statistically significant difference in the number of visits between the surgical group and the control group in the first year/pre-operation(P=0.22).The total cost,cost of medications,cost of AR medications of surgical group were higher than those of the control group(P<0.001,0.001,and 0.002,respectively).The number of visits in the surgical group decreased by 28.3% one year after AT(95%CI:25.2%~31.7%,P<0.001).The total medical expenses,total drug expenses,and AR drug expenses of the surgical group decreased one year after AT:total medical expenses(37.5%,95%CI:37.3%~37.6%,P<0.001),total drug expenses(39.1%,95%CI:38.8%~39.3%,P<0.001),and AR drug expenses(39.5%,95%CI:39.1%~39.8%,P<0.001).Conclusion AT can reduce the number of hospital visits and the cost of treatment and medication.Monitoring and treating adenoid and tonsil hypertrophy and OSA may help to optimizetreatment strategies for AR control.