评估扁桃体切除术对儿童特应性皮炎的影响：跨越三个术后时间段的回顾性分析

文献信息

中文摘要

背景： 扁桃体切除术常用于复发性扁桃体炎的儿童，但其长期免疫学后果仍存争议。扁桃体参与黏膜免疫发育，其切除与包括特应性皮炎在内的过敏性疾病风险增加存在不一致的关联。本研究评估了复发性或慢性扁桃体炎儿童在扁桃体切除术后新发特应性皮炎的发病率。
方法： 采用大型国家数据库进行回顾性队列研究。选取≤18岁的复发性/慢性扁桃体炎儿科患者，根据扁桃体切除状态分组，并依据人口学特征、过敏史和用药情况进行匹配。既往有特应性皮炎者被排除。主要结局为三个术后时间段内的新发特应性皮炎：≤1年、1-3年、3-5年和>5年。计算每个时间段的相对危险度（RR）及置信区间。
结果： 扁桃体切除术与所有随访时间段内特应性皮炎风险显著降低相关。扁桃体切除术后第一年，相对危险度为0.44（95%置信区间[CI] 0.40-0.49，p<0.0001）。第1-3年，相对危险度为0.52（95% CI 0.48-0.57，p<0.0001）。第3-5年相对危险度最高，为0.57（95% CI 0.52-0.63，p<0.0001）。第5年及以后，相对危险度为0.52（95% CI 0.48-0.57，p<0.0001）。
结论： 既往研究报告扁桃体切除术后特应性风险增加，而本分析控制了既存特应性和感染负担。研究结果提示，在适当选择的儿童中，扁桃体切除术可能减轻全身炎症及随后的特应性风险。复发性扁桃体炎儿科患者的扁桃体切除术可能对特应性皮炎具有保护作用，值得进一步研究其潜在免疫学机制。

英文摘要

BACKGROUNDS: Tonsillectomy is commonly performed in children with recurrent tonsillitis, yet its long-term immunologic consequences remain controversial. Tonsils contribute to mucosal immune development, and their removal has been variably associated with increased risk for allergic diseases, including atopic dermatitis. This study assessed the incidence of new-onset atopic dermatitis following tonsillectomy in children with recurrent or chronic tonsillitis.
METHODS: A retrospective cohort study was conducted using a large national database. Pediatric patients (≤18 years) with recurrent/chronic tonsillitis were selected and grouped based on tonsillectomy status and matched based on demographics, allergic history, and medication use. Those with prior atopic dermatitis were excluded. The primary outcome was new-onset atopic dermatitis within three postoperative intervals: ≤1 year, 1-3 years, 3-5 years, and >5 years. Risk ratios (RR) along with confidence intervals were calculated for each time interval.
RESULTS: Tonsillectomy was associated with a significantly lower risk of atopic dermatitis across all follow-up intervals. In the first year after tonsillectomy, relative risk was 0.44 (95% Confidence interval [CI] 0.40 - 0.49, p < 0.0001). In years 1-3, relative risk was 0.52 (95% CI 0.48 - 0.57, p < 0.0001). Years 3-5 had the greatest relative risk at 0.57 (95% CI 0.52 - 0.63, p < 0.0001). At year 5 and later, relative risk was 0.52 (95% CI 0.48 - 0.57, p < 0.0001).
CONCLUSION: Whereas previous studies reported increased atopic risk post-tonsillectomy, this analysis controlled for pre-existing atopy and infection burden. Findings suggest tonsillectomy may reduce systemic inflammation and subsequent atopic risk in appropriately selected children. Tonsillectomy in pediatric patients with recurrent tonsillitis may confer a protective effect against atopic dermatitis, warranting further investigation into the underlying immunological mechanisms.