Fujihara Keiji, Goto Hironobu, Hiraoka Masanobu, Hayashi Masaki, Hotomi Muneki, Tamura Shinji, Kuki Kiyonori, Yamanaka Noboru, Koltai Peter J
Department of Otolaryngology--Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City 641-8509, Japan.
Int J Pediatr Otorhinolaryngol. 2005 Nov;69(11):1515-20. doi: 10.1016/j.ijporl.2005.04.007. Epub 2005 Jun 24.
This report is a preliminary exploration of the concept of a "Tonsillectomy Index" (TI) as an objective tool for quantifying the indications for tonsillectomy for recurrent acute tonsillitis (AT). The TI is derived by multiplying the number of episodes of AT by the number of years during which the episodes of AT occurred. Our objective in this study was to investigate whether there is a relationship between the natural history of AT, the immunological functions of tonsils and our proposed TI. For the natural history of AT, we medically followed 11 children with a history of AT for 5 years. When TI was equal to or greater than 8 (TI> or =8), the children suffered a significantly greater number of episodes of AT. For the immunological portion of our study, we enrolled 36 children and 46 adults undergoing tonsillectomy for either AT (study group) or tonsillar hypertrophy (control group, CG). We analyzed the co-stimulatory signals, CD80 and CD86 on tonsillar B-lymphocytes. The expression rates of CD80 and CD86 in the AT group with TI> or =8 were significantly decreased compared to those with TI was less than 8 (TI<8), as well as with those in control (tonsillar hypertrophy) group. Our preliminary findings suggest that when the TI> or =8, the tonsils have deteriorated immunologically and spontaneous resolution of recurrent AT is less likely to occur, hence tonsillectomy is appropriate. TI may be a useful tool for surgical decision making.
本报告是对“扁桃体切除指数”（TI）这一概念的初步探索，该指数旨在作为一种客观工具，用以量化复发性急性扁桃体炎（AT）行扁桃体切除术的指征。TI通过将AT发作次数乘以AT发作所持续的年数得出。我们在本研究中的目的是调查AT的自然病程、扁桃体的免疫功能与我们提出的TI之间是否存在关联。对于AT的自然病程，我们对11名有AT病史的儿童进行了为期5年的医学随访。当TI等于或大于8（TI≥8）时，这些儿童AT发作次数显著更多。对于我们研究的免疫学部分，我们纳入了36名儿童和46名因AT（研究组）或扁桃体肥大（对照组，CG）而接受扁桃体切除术的成年人。我们分析了扁桃体B淋巴细胞上的共刺激信号CD80和CD86。与TI小于8（TI<8）的AT组以及对照组（扁桃体肥大组）相比，TI≥8的AT组中CD80和CD86的表达率显著降低。我们的初步研究结果表明，当TI≥8时，扁桃体的免疫功能已恶化，复发性AT自发缓解的可能性较小，因此扁桃体切除术是合适的。TI可能是手术决策的有用工具。
