纤维鼻咽镜在儿童腺样体肥大伴变应性鼻炎中的应用价值

Clinical value of fiber nasopharyngoscope applied in adenoid hypertrophy combined with allergic rhinitis in children

目的探讨纤维鼻咽镜在儿童腺样体肥大(AH)伴变应性鼻炎(AR)中的应用价值。方法回顾性分析2021年1月—2024年3月于该院耳鼻喉科就诊的174例患儿的临床资料。其中,129例经纤维鼻咽镜检查确诊为AH(79例患儿伴AR,设为AH伴AR组;余下50例未合并AR的单纯AH患儿设为AH组),45例经纤维鼻咽镜检查无AH的单纯AR患儿设为AR组。同时选择同期来该院儿童保健科行健康检查的25名健康儿童设为健康对照组(HC组)。所有患儿入院当日均行鼻咽部X线侧位片检查,并计算腺样体最大厚度与鼻咽腔前后径比值(A/N比值);测定外周血嗜酸性粒细胞(EOS)百分比、血清白细胞介素-17(IL-17)和肿瘤坏死因子-α(TNF-α)水平。比较AH伴AR组、AH组、AR组和HC组A/N比值、外周血EOS百分比、血清IL-17和TNF-α水平。比较AH伴AR组纤维鼻咽镜下不同腺样体阻塞程度患儿A/N比值及外周血EOS百分比、血清IL-17和TNF-α水平。使用Spearman相关系数分析AH伴AR患儿纤维鼻咽镜下腺样体阻塞程度与外周血EOS百分比、血清IL-17和TNF-α水平的相关性。结果A/N比值:AH伴AR组大于AH组(P<0.05),AH组大于AR组(P<0.05),AR组大于HC组(P<0.05)。外周血EOS百分比、血清IL-17和TNF-α水平:AH伴AR组都高于AR组(P<0.05),AR组都高于AH组(P<0.05),AH组都高于HC组(P<0.05)。AH伴AR组中纤维鼻咽镜下腺样体阻塞程度为Ⅲ至Ⅳ度患儿的A/N比值、外周血EOS百分比、血清IL-17和TNF-α水平,都明显高于Ⅰ至Ⅱ度患儿(P<0.05)。Spearman相关性分析显示,AH伴AR患儿纤维鼻咽镜下腺样体阻塞程度与外周血EOS百分比、血清IL-17和TNF-α水平呈正相关(r值分别为0.527、0.451和0.402,P<0.05)。结论纤维鼻咽镜可应用于儿童AH伴AR诊断,结合外周血EOS百分比、血清IL-17和TNF-α水平检测,有助于判断患儿病情严重程度,具有积极指导意义。

Objective To investigate the clinical value of fiber nasopharyngoscope applied in adenoid hypertrophy(AH)combined with allergic rhinitis(AR)in children.Methods Clinical data of 174 pediatric patients from January 2021 to March 2024 was collected and analyzed.Among them,129 cases were diagnosed with AH via fiber nasopharyngoscope examination(79 cases with AR were assigned to the AH with AR group,the remaining 50 cases of simple AH without AR were assigned to the AH group),and 45 cases of simple AR without AH through fiber nasopharyngoscope examination were assigned to the AR group.And 25 healthy children who came to our pediatric health department for health examinations during the same period were selected as the healthy control(HC)group.On the day of admission,all subjects underwent lateral X-ray examination of the nasopharynx,and the ratio of the maximum thickness of adenoids to the anterior posterior diameter of the nasopharynx cavity(A/N ratio)was calculated.Meanwhile their of peripheral blood eosinophil(EOS)percentage,serum interleukin-17(IL-17),and tumor necrosis factor-α(TNF-α)levels were tested.The A/N ratio,peripheral blood EOS percentage,serum IL-17 and TNF-αlevels were compared among the AH with AR group,AH group,AR group,and HC group.The A/N ratio,peripheral blood EOS percentage,serum IL-17 and TNF-αlevels of children with different degrees of adenoid obstruction under fiber nasopharyngoscope were compared in AH and AR group.Spearman correlation coefficient was used to analyze the correlation between the degree of adenoid obstruction under fiber nasopharyngoscope and the levels of peripheral blood EOS percentage,serum IL-17 and TNF-αin children from AH and AR group.Result A/N ratio:the value in AH with AR group was higher than that in AH group(P<0.05),the value in AH group was higher than that in AR group(P<0.05),and the value in AR group was higher than that in HC group(P<0.05).Peripheral blood EOS percentage,serum IL-17 and TNF-αlevels:AH with AR group had higher levels than those in AR group(P<0.05),AR group had higher levels than those in AH group(P<0.05),and AH group had higher levels than those in HC group(P<0.05).The A/N ratio,peripheral blood EOS percentage,serum IL-17 and TNF-αlevels in children with adenoid obstruction degreeⅢ~Ⅳunder fiber nasopharyngoscope in the AH group were significantly higher than those in children with degreeⅠ~Ⅱ(P<0.05).Spearman correlation analysis showed that the degree of adenoid obstruction under fiber nasopharyngoscope in children with AH accompanied by AR significantly positively correlated with peripheral blood EOS percentage,serum IL-17 and TNF-αlevels(r values were 0.527,0.451,and 0.402 respectively,P<0.05).Conclusion Fiber nasopharyngoscope can be used for the diagnosis of AH with AR in children,and can be positive in determining severity of the patient's condition when combined with peripheral blood EOS percentage,serum IL-17 and TNF-αlevels.