山东大学耳鼻喉眼学报 ›› 2025, Vol. 39 ›› Issue (5): 34-41.doi: 10.6040/j.issn.1673-3770.0.2023.373

• 论著 • 上一篇    

儿童过敏性鼻炎、扁桃体腺样体肥大和鼻窦炎之间相关性及其对临床指导价值

黄焕1,2,华红利3,邓玉琴3,江承洋4,王雨薇1,2,杨星海4   

  1. 1.武汉科技大学湖北省妇幼保健院研究生联合培养基地, 湖北 武汉 430070;
    2.武汉科技大学医学部 医学院, 湖北 武汉 430065;
    3.武汉大学人民医院 耳鼻咽喉头颈外科, 湖北 武汉 430070;
    4.华中科技大学同济医学院附属湖北省妇幼保健院 小儿外科, 湖北 武汉 430063
  • 发布日期:2025-09-19
  • 通讯作者: 杨星海. E-mail:75493654@qq.com
  • 基金资助:
    国家自然科学基金面上项目(81970860)

Correlation of allergic rhinitis, tonsil adenoid hypertrophy, and sinusitis in children and analysis of its clinical guiding value

HUANG Huan1,2, HUA Hongli3, DENG Yuqin3, JIANG Chengyang4, WANG Yuwei1,2, YANG Xinghai4   

  1. 1. Wuhan University of Science and Technology & Maternal and Child Hospital of Hubei Province Graduate Joint Training Base, Wuhan 430070, Hubei, China2. Medical College, Medical Department of Wuhan University of Science and Technology, Wuhan 430065, Hubei, China3. Department of Otorhinolaryngology & Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China4. Department of Pediatric Surgery, Maternal and Child Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430070, Hubei, China
  • Published:2025-09-19

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摘要： 目的 探究儿童过敏性鼻炎、扁桃体肥大、腺样体肥大及鼻窦炎之间的相关性并分析其对临床指导价值。 方法 回顾性分析因睡眠问题接受诊治的1 275例3~14岁患儿的病例资料,收集患者性别、年龄、过敏原皮肤点刺试验、头颅侧位片、鼻窦CT和门诊病史及体格检查等资料。对过敏性鼻炎、扁桃体肥大、腺样体肥大及鼻窦炎之间相关性进行分析,并对不同扁桃体肥大程度患者过敏性鼻炎对腺样体肥大的影响及不同年龄段腺样体肥大与鼻窦炎之间关联进行深入探讨。 结果 儿童过敏性鼻炎与扁桃体肥大及鼻窦炎无明显相关。相比于非过敏性鼻炎患者,过敏性鼻炎患者主要表现为腺样体中度肥大。腺样体与扁桃体肥大程度呈正相关,对于扁桃体Ⅰ~Ⅱ度肥大患者,有无过敏性鼻炎其腺样体肥大程度情况有差异,但扁桃体Ⅲ~Ⅳ度肥大患者则未见明显差异。腺样体肥大患者鼻窦炎患病率和Lund Mackay评分均高于正常儿童,但鼻窦炎与腺样体肥大患者的腺样体肥大程度无明显相关。此外6~9岁患者鼻窦炎严重程度与腺样体肥大相关,而<6岁和>10岁患者则无明显相关。 结论 过敏性鼻炎对腺样体肥大程度存在影响,但与扁桃体肥大和鼻窦炎无明显相关。过敏性鼻炎对腺样体肥大程度的影响与扁桃体肥大程度有关。鼻窦炎的发生及严重程度均与腺样体肥大患者的腺样体肥大程度无明显相关。鼻窦炎严重程度与腺样体肥大是否存在关联与年龄相关。

关键词: 儿童, 过敏性鼻炎, 腺样体肥大, 扁桃体肥大, 鼻窦炎, 相关性分析

Abstract: Objective This study aimed to study the correlation between allergic rhinitis, tonsil hypertrophy, adenoid hypertrophy, and sinusitis in children and analyze its clinical value. Methods The clinical data of 1,275 children aged 3-14 years old, who treated for sleep problems were retrospectively analyzed. Data on sex, age, skin prick test for allergens, lateral skull radiography, sinus computed tomography, outpatient history, and physical examination were collected. The study analyzed the correlation between allergic rhinitis, tonsil hypertrophy, adenoid hypertrophy, and sinusitis. It also discussed the influence of allergic rhinitis on adenoid hypertrophy in patients with different degrees of tonsil hypertrophy and the correlation between adenoid hypertrophy and sinusitis at different ages. Results Allergic rhinitis was not significantly associated with tonsil hypertrophy or sinusitis in children. Compared to non-allergic rhinitis patients, patients with allergic rhinitis primarily presented with moderate adenoid hypertrophy. Notably, adenoids were positively correlated with tonsil hypertrophy. In patients with grades Ⅰ-Ⅱ tonsil hypertrophy, the degree of adenoid hypertrophy differed between patients with and without allergic rhinitis. However, no significant difference was observed between patients with grades Ⅲ-Ⅳ tonsil hypertrophy. The prevalence of sinusitis and Lund-Mackay scores were higher in patients with adenoid hypertrophy compared to children with normal adenoid size. Nonetheless, there was no significant correlation between sinusitis and the degree of adenoid hypertrophy in patients with the condition. Interestingly, the severity of sinusitis in patients aged 6-9 years was associated with adenoid hypertrophy, while no significant correlation was found in patients aged less than 6 and older than 10 years. Conclusion Allergic rhinitis affected the degree of adenoid hypertrophy, but had no significant correlation with tonsil hypertrophy or sinusitis. Specifically, whether allergic rhinitis affected the degree of adenoid hypertrophy depended on the degree of tonsil hypertrophy. In patients with adenoid hypertrophy, the occurrence and severity of sinusitis did not significantly correlate with the degree of adenoid hypertrophy. However, the association between sinusitis and adenoid hypertrophy was age-related.

Key words: Children, Allergic rhinitis, Adenoid hypertrophy, Tonsil hypertrophy, Sinusitis, Correlation analysis

中图分类号: 

  • R762
[1] Bousquet J, Anto JM, Bachert C, et al. Allergic rhinitis[J]. Nat Rev Dis Primers, 2020, 6(1): 95. doi:10.1038/s41572-020-00227-0
[2] Lin SY, Su YX, Wu YC, et al. Management of paediatric obstructive sleep apnoea: a systematic review and network meta-analysis[J]. Int J Paediatr Dent, 2020, 30(2): 156-170. doi:10.1111/ipd.12593
[3] Ramadan HH. Pediatric chronic rhinosinusitis[J]. Eur Arch Oto Rhino Laryngol, 2024, 281(3): 1131-1137. doi:10.1007/s00405-023-08307-z
[4] Ciprandi G, Gallo F, Damiani V, et al. Tonsil volume may predict adenoid size: a real-life study[J]. Acta Biomed, 2020, 91(1-S): 77-80. doi:10.23750/abm.v91i1-S.9231
[5] Yang YC, Li XY, Ma Q, et al. Detecting epidemiological relevance of adenoid hypertrophy, rhinosinusitis, and allergic rhinitis through an Internet search[J]. Eur Arch Otorhinolaryngol, 2022, 279(3): 1349-1355. doi:10.1007/s00405-021-06885-4
[6] Ameli F, Brocchetti F, Tosca MA, et al. Tonsil volume and allergic rhinitis in children[J]. Allergy Rhinol, 2014, 5(3): 137-142. doi:10.2500/ar.2014.5.0095
[7] Zhang CX, Zhang H, Tang QP, et al. Allergic rhinitis as an independent risk factor for postoperative recurrence of children chronic sinusitis[J]. Children, 2023, 10(7): 1207. doi:10.3390/children10071207
[8] 赵迪, 王萌, 曹志伟. 腺样体肥大与变应性鼻炎的相关性研究进展[J]. 中国医科大学学报, 2022, 51(6): 543-547. doi:10.12007/j.issn.0258-4646.2022.06.013 ZHAO Di, WANG Meng, CAO Zhiwei. Correlation between adenoid hypertrophy and allergic rhinitis[J]. Journal of China Medical University, 2022, 51(6): 543-547. doi:10.12007/j.issn.0258-4646.2022.06.013
[9] 张薇, 葛文彤, 唐力行, 等. 儿童慢性鼻窦炎合并腺样体肥大菌谱及预后相关因素分析[J]. 中国耳鼻咽喉颅底外科杂志, 2021, 27(2): 151-156. doi:10.11798/j.issn.1007-1520.202121057 ZHANG Wei, GE Wentong, TANG Lixing, et al. Analysis of bacterial spectrum and related factors in children with chronic rhinosinusitis and adenoid hypertrophy[J]. Chinese Journal of Otorhinolaryngology-Skull Base Surgery, 2021, 27(2): 151-156. doi:10.11798/j.issn.1007-1520.202121057
[10] Bousquet J, Hellings PW, Agache I, et al. Allergic Rhinitis and its Impact on Asthma(ARIA)Phase 4(2018): change management in allergic rhinitis and asthma multimorbidity using mobile technology[J]. J Allergy Clin Immunol, 2019, 143(3): 864-879. doi:10.1016/j.jaci.2018.08.049
[11] Working Group of Chinese Guideline for the Diagnosis and Treatment of Childhood OSA, Society of Otorhinolaryngology Head and Neck Surgery Subspecialty Group of Pediatrics, Subspecialty Group of Respiratory Diseases SOP, et al. Chinese guideline for the diagnosis and treatment of childhood obstructive sleep apnea(2020)[J]. Pediatr Investig, 2021, 5(3): 167-187. doi:10.1002/ped4.12284
[12] Fujioka M, Young LW, Girdany BR. Radiographic evaluation of adenoidal size in children: adenoidal-nasopharyngeal ratio[J]. AJR Am J Roentgenol, 1979, 133(3): 401-404. doi:10.2214/ajr.133.3.401
[13] Zhao TT, Zhou JW, Yan JR, et al. Automated adenoid hypertrophy assessment with lateral cephalometry in children based on artificial intelligence[J]. Diagnostics, 2021, 11(8): 1386. doi:10.3390/diagnostics11081386
[14] 汤文勤, 徐小炉, 陈勇强. 鼻咽部侧位X线片在儿童腺样体肥大诊断中的应用[J]. 安徽医学, 2021, 42(6): 648-650. doi:10.3969/j.issn.1000-0399.2021.06.015 TANG Wenqin, XU Xiaolu, CHEN Yongqiang. Application of lateral nasopharyngeal X-ray film in the diagnosis of adenoidal hypertrophy in children[J]. Anhui Medical Journal, 2021, 42(6): 648-650. doi:10.3969/j.issn.1000-0399.2021.06.015
[15] Kugelman N, Ronen O, Stein N, et al. Adenoid obstruction assessment in children: clinical evaluation versus endoscopy and radiography[J]. Isr Med Assoc J, 2019, 21(6): 376-380.
[16] Friedman M, Tanyeri H, La Rosa M, et al. Clinical predictors of obstructive sleep apnea[J]. Laryngoscope, 1999, 109(12): 1901-1907. doi:10.1097/00005537-199912000-00002
[17] Fokkens WJ, Lund VJ, Hopkins C, et al. European position paper on rhinosinusitis and nasal polyps 2020[J]. Rhinology, 2020, 58(Suppl S29): 1-464. doi:10.4193/Rhin20.600
[18] Lund VJ, Kennedy DW. Staging for rhinosinusitis[J]. Otolaryngol Head Neck Surg, 1997, 117(3 Pt 2): S35-S40. doi:10.1016/S0194-59989770005-6
[19] 冯晨, 郭瑞祥, 王岩. 等离子射频消融术在儿童阻塞性睡眠呼吸暂停中的应用和进展[J]. 山东大学耳鼻喉眼学报, 2021, 35(2): 16-21. doi:10.6040/j.issn.1673-3770.1.2020.105 FENG Chen, GUO Ruixiang, WANG Yan. Application and progress of coblation in children with obstructive sleep apnea[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(2): 16-21. doi:10.6040/j.issn.1673-3770.1.2020.105
[20] Colavita L, Miraglia Del Giudice M, Stroscio G, et al. Allergic rhinitis and adenoid hypertrophy in children: is adenoidectomy always really useful?[J]. J Biol Regul Homeost Agents, 2015, 29(2 Suppl 1): 58-63
[21] Paramaesvaran S, Ahmadzada S, Eslick GD. Incidence and potential risk factors for adenoid regrowth and revision adenoidectomy: a meta-analysis[J]. Int J Pediatr Otorhinolaryngol, 2020, 137: 110220. doi:10.1016/j.ijporl.2020.110220
[22] 朱源, 魏萍, 寇巍, 等. 预防腺样体肥大术后复发的策略探讨[J]. 临床耳鼻咽喉头颈外科杂志, 2022, 36(10):807-812. doi:10.13201/j.issn.2096-7993.2022.10.016 ZHU Yuan, WEI Ping, KOU Wei, et al. Strategies for preventing postoperative recurrence of adenoid hypertrophy[J]. J Clin Otorhinolaryngol Head Neck Surg, 2022, 36(10):807-812. doi:10.13201/j.issn.2096-7993.2022.10.016
[23] Arslan E, Tulaci KG, Canakci H, et al. Evaluation of the intranasal steroid treatment outcomes in adenoid tissue hypertrophy with or without allergic rhinitis[J]. Am J Otolaryngol, 2021, 42(4): 102983. doi:10.1016/j.amjoto.2021.102983
[24] Liu WL, Zhou LF, Zeng QX, et al. Combination of mometasone furoate and oxymetazoline for the treatment of adenoid hypertrophy concomitant with allergic rhinitis: a randomized controlled trial[J]. Sci Rep, 2017, 7: 40425. doi:10.1038/srep40425
[25] Naqi SA, Ashfaq AH, Umar MA, et al. Clinical outcome of Montelukast Sodium in Children with Adenoid Hypertrophy[J]. Pak J Med Sci, 2021, 37(2): 362-366. doi:10.12669/pjms.37.2.2670
[26] 许丽瑶, 黎乐平, 刘洋, 等. 粉尘螨滴剂脱敏治疗鼻炎合并腺样体肥大患儿的临床疗效[J]. 当代医学, 2020, 26(7): 40-42. doi:10.3969/j.issn.1009-4393.2020.07.013 XU Liyao, LI Leping, LIU Yang, et al. Clinical efficacy of Dermatophagoides farinae drops desensitization in children with rhinitis and adenoidal hypertrophy[J]. Contemporary Medicine, 2020, 26(7): 40-42. doi:10.3969/j.issn.1009-4393.2020.07.013
[27] 皮本元, 佘文胜. 粉尘螨滴剂脱敏治疗鼻炎并腺样体肥大患儿的临床分析[J]. 西南国防医药, 2017, 27(3): 259-261. doi:10.3969/j.issn.1004-0188.2017.03.015 PI Benyuan, SHE Wensheng. Clinical analysis of dermatophagoides farinae drops on allergic rhinitis and adenoid hypertrophy in children[J]. Medical Journal of National Defending Forces in Southwest China, 2017, 27(3): 259-261. doi:10.3969/j.issn.1004-0188.2017.03.015
[28] Quaranta N, Milella C, Iannuzzi L, et al. A study of the role of different forms of chronic rhinitis in the development of otitis media with effusion in children affected by adenoid hypertrophy[J]. Int J Pediatr Otorhinolaryngol, 2013, 77(12): 1980-1983. doi:10.1016/j.ijporl.2013.09.017
[29] Kim MS, Kim SY, Choi HG. Adenoidectomy may not be effective to reduce the number of hospital visits for sinusitis[J]. J Korean Med Sci, 2018, 33(10): e78. doi:10.3346/jkms.2018.33.e78
[30] 王晓嫒, 张欠欠, 程翔宇, 等. 翼管神经切断术治疗2型慢性鼻窦炎伴过敏性鼻炎的临床疗效分析[J]. 山东大学耳鼻喉眼学报, 2023, 37(5): 42-49. doi:10.6040/j.issn.1673-3770.0.2022.471 WANG Xiaoai, ZHANG Qianqian, CHENG Xiangyu, et al. A clinical efficacy analysis of vidian neurectomy in the treatment of type 2 chronic rhinosinusitis with allergic rhinitis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(5): 42-49. doi:10.6040/j.issn.1673-3770.0.2022.471
[31] Sedaghat AR, Phipatanakul W, Cunningham MJ. Atopy and the development of chronic rhinosinusitis in children with allergic rhinitis[J]. J Allergy Clin Immunol Pract, 2013, 6(1): 689-691
[32] 万霞, 孔勇刚, 陈始明, 等. 嗜酸性粒细胞与非嗜酸性粒细胞慢性鼻-鼻窦炎患者鼻窦CT特征比较[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 275-280. doi:10.6040/j.issn.1673-3770.0.2022.050 WAN Xia, KONG Yonggang, CHEN Shiming, et al. Comparison of sinus computed tomography characteristics in patients with eosinophil and non-eosinophil chronic nasosinusitis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 275-280. doi:10.6040/j.issn.1673-3770.0.2022.050
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