腺样体切除术对呼吸功能的影响：一项随机前瞻性研究
2009/03/20
目的：患有复发性中耳炎的儿童其发生儿童期哮喘的风险增加，这可能与这些儿童中呼吸道感染反复发生有关。腺样体切除术是一种常见的儿童期手术，但目前我们还不清楚腺样体切除术的作用。本研究评价了腺样体切除术在特应质的发展和体现哮喘特征的呼吸功能改变中的作用。
试验设计：本研究为随机对照研究。
背景：三级医疗中心。
患者：在随机化后，我们对166名12～48个月、患有复发性中耳炎或持续性中耳炎的患儿进行了为期3年的随访。
干预措施：患儿随机分配，进行鼓膜切开置管，伴有或不伴有腺样体切除术。
主要测定项目：主要结局为脉冲振荡法评估的运动诱发的支气管收缩。次要结局为呼气一氧化氮水平评估的支气管炎症和皮肤点刺试验评估的特异反应性。在3年的随访期间，在患者日志中记录中耳炎的发作次数。
结果：腺样体切除术并未显著影响基线的肺功能、运动诱发的支气管收缩、呼气一氧化氮水平、皮肤点刺试验阳性结果或医生确诊的哮喘。腺样体切除术不能显著预防中耳炎。随访第1年，不管是否进行了腺样体切除术，复发性中耳炎（>/=4次）与运动诱发的支气管收缩异常（OR 6.62, 95% CI 1.27-34）和呼气一氧化氮水平升高（OR 3.26, 95% CI 0.98-10.8）均有关。
结论：腺样体切除术不会促进哮喘或过敏。儿童早期呼吸道感染反复发生与支气管高反应性有关。
（林江涛 审校）
Mattila PS, et al. Arch Dis Child. 2009 Jan 8. [Epub ahead of print] Links
Mattila PS, et al. Arch Dis Child. 2009 Jan 8. [Epub ahead of print] Links
Effect of Adenoidectomy on Respiratory Function. A Randomized Prospective Study.
OBJECTIVE: Risk of childhood asthma is increased in children with recurrent otitis media. This may be associated with recurrent respiratory tract infections in these children, but the role of adenoidectomy, a frequent operation during childhood, is unknown. Here, we evaluated the role of adenoidectomy in the development of atopy and respiratory function changes characteristic of asthma. DESIGN: Randomized controlled study.
SETTING: Tertiary care center. Patients: One hundred sixty-six children aged 12 to 48 months who had recurrent or persistent otitis media and who were followed-up for three years after randomization.
INTERVENTION: Randomization to undergo insertion of tympanostomy tubes with or without adenoidectomy.
MAIN OUTCOME MEASURES: The primary out-come measure was exercise-induced bronchoconstriction as evaluated by impulse oscillometry. The secondary out-come measures were bronchial inflammation as evaluated by exhaled nitric oxide and atopy as evaluated by skin prick tests. During the 3-year follow-up otitis media episodes were documented in patient diaries.
RESULTS: Adenoidectomy did not significantly influence baseline lung function, exercise-induced bronchoconstriction, exhaled nitric oxide concentration, development of positive skin prick tests, or doctor-diagnosed asthma. Adenoidectomy did not significantly prevent otitis media. Recurrent otitis media (>/=4 episodes) during the first follow-up year were associated with an abnormal exercise-induced bronchoconstriction (OR 6.62, 95% CI 1.27-34) and an elevated exhaled nitric oxide concentration (OR 3.26, 95% CI 0.98-10.8) regardless of adenoidectomy.
CONCLUSIONS: Adenoidectomy did not promote asthma or allergy. Recurrent respiratory tract infections during early childhood are associated with the risk of bronchial hyperreactivity.
试验设计：本研究为随机对照研究。
背景：三级医疗中心。
患者：在随机化后，我们对166名12～48个月、患有复发性中耳炎或持续性中耳炎的患儿进行了为期3年的随访。
干预措施：患儿随机分配，进行鼓膜切开置管，伴有或不伴有腺样体切除术。
主要测定项目：主要结局为脉冲振荡法评估的运动诱发的支气管收缩。次要结局为呼气一氧化氮水平评估的支气管炎症和皮肤点刺试验评估的特异反应性。在3年的随访期间，在患者日志中记录中耳炎的发作次数。
结果：腺样体切除术并未显著影响基线的肺功能、运动诱发的支气管收缩、呼气一氧化氮水平、皮肤点刺试验阳性结果或医生确诊的哮喘。腺样体切除术不能显著预防中耳炎。随访第1年，不管是否进行了腺样体切除术，复发性中耳炎（>/=4次）与运动诱发的支气管收缩异常（OR 6.62, 95% CI 1.27-34）和呼气一氧化氮水平升高（OR 3.26, 95% CI 0.98-10.8）均有关。
结论：腺样体切除术不会促进哮喘或过敏。儿童早期呼吸道感染反复发生与支气管高反应性有关。
（林江涛 审校）
Mattila PS, et al. Arch Dis Child. 2009 Jan 8. [Epub ahead of print] Links
Mattila PS, et al. Arch Dis Child. 2009 Jan 8. [Epub ahead of print] Links
Effect of Adenoidectomy on Respiratory Function. A Randomized Prospective Study.
OBJECTIVE: Risk of childhood asthma is increased in children with recurrent otitis media. This may be associated with recurrent respiratory tract infections in these children, but the role of adenoidectomy, a frequent operation during childhood, is unknown. Here, we evaluated the role of adenoidectomy in the development of atopy and respiratory function changes characteristic of asthma. DESIGN: Randomized controlled study.
SETTING: Tertiary care center. Patients: One hundred sixty-six children aged 12 to 48 months who had recurrent or persistent otitis media and who were followed-up for three years after randomization.
INTERVENTION: Randomization to undergo insertion of tympanostomy tubes with or without adenoidectomy.
MAIN OUTCOME MEASURES: The primary out-come measure was exercise-induced bronchoconstriction as evaluated by impulse oscillometry. The secondary out-come measures were bronchial inflammation as evaluated by exhaled nitric oxide and atopy as evaluated by skin prick tests. During the 3-year follow-up otitis media episodes were documented in patient diaries.
RESULTS: Adenoidectomy did not significantly influence baseline lung function, exercise-induced bronchoconstriction, exhaled nitric oxide concentration, development of positive skin prick tests, or doctor-diagnosed asthma. Adenoidectomy did not significantly prevent otitis media. Recurrent otitis media (>/=4 episodes) during the first follow-up year were associated with an abnormal exercise-induced bronchoconstriction (OR 6.62, 95% CI 1.27-34) and an elevated exhaled nitric oxide concentration (OR 3.26, 95% CI 0.98-10.8) regardless of adenoidectomy.
CONCLUSIONS: Adenoidectomy did not promote asthma or allergy. Recurrent respiratory tract infections during early childhood are associated with the risk of bronchial hyperreactivity.
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土耳其变态反应的患病率和危险因素（PARFAIT）：成人多中心横断面研究的结果
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呼吸道合胞病毒感染住院治疗和哮喘间相关性的因果关系
