van den Akker Emma H, Sanders Elisabeth A M, van Staaij Birgit K, Rijkers Ger T, Rovers Maroeska M, Hoes Arno W, Schilder Anne G M
Department of Otorhinolaryngology, Wilhelmina Children's Hospital/University Medical Center Utrecht, The Netherlands.
Ann Allergy Asthma Immunol. 2006 Aug;97(2):251-6. doi: 10.1016/S1081-1206(10)60022-1.
It remains controversial whether pediatric adenotonsillectomy ultimately results in decreased serum immunoglobulin levels and if so whether such a decrease is associated with increased susceptibility to upper respiratory tract infections (URIs).
To evaluate changes in serum immunoglobulin levels in relation to occurrence of URIs in children participating in a randomized controlled trial on the effectiveness of adenotonsillectomy.
A total of 300 children aged 2 to 8 years, with symptoms of recurrent throat infections or tonsillar hypertrophy, were randomly assigned to either adenotonsillectomy or watchful waiting (WW). Serum samples were collected at baseline and at 1-year follow-up. Occurrence of throat infections and other URIs during first-year follow-up was recorded in a diary by the child's parents.
Paired serum samples were available for 123 children (63 in the adenotonsillectomy group and 60 in the WW group). IgG1 and IgG2 levels decreased but remained within the reference range for age in both study arms. IgM and IgA levels decreased as well but remained elevated. The IgA level in the adenotonsillectomy group decreased in significantly greater degree compared with the WW group, but this difference disappeared in cases where children experienced frequent URIs. In general, no relation between immunoglobulin levels and the number of throat infections or URIs at 1-year follow-up was found.
Immunoglobulin levels of children undergoing adenotonsillectomy decreased from elevated to slightly elevated or reference values for age during 1-year follow-up irrespective of treatment (adenotonsillectomy or WW). IgA showed a greater decrease in the adenotonsillectomy group but rose to levels comparable with the WW group in cases of frequent URIs. This finding indicates that the remaining mucosa-associated lymphoid tissue can compensate for the loss of tonsil and adenoid tissue.
小儿腺样体扁桃体切除术最终是否会导致血清免疫球蛋白水平降低，以及如果确实如此，这种降低是否与上呼吸道感染（URI）易感性增加相关，目前仍存在争议。
在一项关于腺样体扁桃体切除术有效性的随机对照试验中，评估儿童血清免疫球蛋白水平的变化与URI发生情况的关系。
总共300名2至8岁、有反复咽喉感染症状或扁桃体肥大的儿童被随机分配接受腺样体扁桃体切除术或观察等待（WW）。在基线和1年随访时采集血清样本。儿童家长通过日记记录第一年随访期间咽喉感染和其他URI的发生情况。
123名儿童（腺样体扁桃体切除组63名，WW组60名）有配对的血清样本。IgG1和IgG2水平下降，但在两个研究组中均保持在年龄参考范围内。IgM和IgA水平也下降，但仍高于正常水平。腺样体扁桃体切除组的IgA水平下降程度明显大于WW组，但在频繁发生URI的儿童中，这种差异消失。总体而言，在1年随访时未发现免疫球蛋白水平与咽喉感染或URI次数之间存在关联。
无论接受何种治疗（腺样体扁桃体切除术或WW），接受腺样体扁桃体切除术的儿童在1年随访期间免疫球蛋白水平从升高降至略高于或处于年龄参考值。腺样体扁桃体切除组的IgA下降幅度更大，但在频繁发生URI的情况下，其水平上升至与WW组相当。这一发现表明，剩余的黏膜相关淋巴组织可以补偿扁桃体和腺样体组织的损失。
