腺样体肥大患儿鼻窦炎和阻塞性睡眠呼吸暂停的临床表型特征及危险因素

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中文摘要

背景： 腺样体肥大（AH）是一种常见的儿童疾病，常与多种合并症相关。然而，其具体的临床表型以及关键并发症的独立危险因素，尤其是在需要手术的儿童中，仍未得到充分阐明。
方法： 这项回顾性队列研究纳入了161例因AH接受手术的儿童。收集了人口学数据、疾病严重程度指标、合并症和实验室结果。采用描述性统计、卡方检验和多因素logistic回归模型进行数据分析。
结果： 中位年龄为91个月。鼻窦炎是最常见的合并症（64.6%），其次是过敏性鼻炎（27.3%）和阻塞性睡眠呼吸暂停（OSA，26.1%）。多因素分析确定过敏性鼻炎是鼻窦炎的独立危险因素（调整比值比[aOR]=2.51，95%置信区间[CI]：1.16-5.70，P=0.017）。对于OSA，扁桃体肥大分级是最强的独立预测因子（aOR=2.90，95%CI：1.57-5.44，P<0.001），其影响超过腺样体肥大。
结论： 需要手术的AH患儿表现出复杂的多重疾病特征。过敏性鼻炎显著增加鼻窦炎风险，而扁桃体肥大是OSA的关键解剖学预测因子。临床评估和管理应同时处理过敏状态和全面的鼻口咽阻塞。

英文摘要

BACKGROUND: Adenoid hypertrophy (AH) is a common childhood condition frequently associated with multiple comorbidities. However, its specific clinical phenotype and the independent risk factors for key complications, particularly in children requiring surgery, remain inadequately elucidated.
METHODS: This retrospective cohort study included 161 children undergoing surgery for AH. Demographic data, disease severity indicators, comorbidities, and laboratory results were collected. Descriptive statistics, chi-square tests, and multivariate logistic regression models were used for data analysis.
RESULTS: The median age was 91 months. Sinusitis was the most common comorbidity (64.6%), followed by allergic rhinitis (27.3%) and obstructive sleep apnea (OSA, 26.1%). Multivariate analysis identified allergic rhinitis as an independent risk factor for sinusitis (adjusted odds ratio [aOR] = 2.51, 95% confidence interval [CI]: 1.16-5.70, P = 0.017). For OSA, tonsil hypertrophy grade was the strongest independent predictor (aOR = 2.90, 95% CI: 1.57 - 5.44, P < 0.001), outweighing the effect of adenoid hypertrophy.
CONCLUSION: Children with AH requiring surgery present with a complex multimorbidity profile. Allergic rhinitis significantly increases the risk of sinusitis, while tonsil hypertrophy is the key anatomical predictor for OSA. Clinical assessment and management should concurrently address allergic status and comprehensive naso-oropharyngeal obstruction.