Guimaraes Carolina V A, Kalra Maninder, Donnelly Lane F, Shott Sally R, Fitz Kelly, Singla Saroj, Amin Raouf S
Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH 45229-3039, USA.
AJR Am J Roentgenol. 2008 Apr;190(4):973-5. doi: 10.2214/AJR.07.3020.
Enlargement of the lingual tonsils is being increasingly recognized as a not uncommon and treatable cause of obstructive sleep apnea, particularly in patients with Down syndrome who have undergone palatine tonsillectomy and adenoidectomy. We have recognized an increasing number of patients who are obese and have obstructive sleep apnea with enlarged lingual tonsils. The purpose of this study was to evaluate the frequency of enlarged lingual tonsils in obese children.
Seventy-one obese children (mean body mass index = 41.6 kg/m(2)) underwent sagittal fast spin-echo inversion recovery imaging. Lingual tonsils were identified and measured in the greatest anteroposterior diameter. Lingual tonsils > 10 mm were considered markedly enlarged. The subgroup with absent palatine tonsils (previous tonsillectomy) (n = 41) were compared with those with palatine tonsils present (n = 30).
Forty-four (62%) of the obese children had measurable lingual tonsils, which is greater than the frequency previously reported in normal subjects (0%), subjects with obstructive sleep apnea (33%), or subjects with Down syndrome and obstructive sleep apnea (50%). Ten (14%) had lingual tonsils > 10 mm. Obese subjects with absent palatine tonsils (previous tonsillectomy) had a higher prevalence of measurable lingual tonsils than those with palatine tonsils (78% vs 22%, respectively; p < 0.001) and a higher prevalence of lingual tonsils > 10 mm (90% vs 10%, p < 0.001).
Obese children have a high frequency of enlargement of the lingual tonsils with a significantly higher prevalence in those with previous tonsillectomy. Enlarged lingual tonsils may play a role in the pathogenesis of obstructive sleep apnea in obese children.
舌扁桃体增大日益被认为是阻塞性睡眠呼吸暂停的常见且可治疗病因，尤其是在已接受腭扁桃体切除术和腺样体切除术的唐氏综合征患者中。我们发现越来越多肥胖且患有阻塞性睡眠呼吸暂停并伴有舌扁桃体增大的患者。本研究的目的是评估肥胖儿童中舌扁桃体增大的发生率。
71名肥胖儿童（平均体重指数 = 41.6 kg/m²）接受矢状面快速自旋回波反转恢复成像。识别并测量舌扁桃体的最大前后径。舌扁桃体前后径>10 mm被认为明显增大。将无腭扁桃体（既往扁桃体切除术）的亚组（n = 41）与有腭扁桃体的亚组（n = 30）进行比较。
44名（62%）肥胖儿童有可测量的舌扁桃体，这一发生率高于先前报道的正常受试者（0%）、阻塞性睡眠呼吸暂停患者（33%）或唐氏综合征合并阻塞性睡眠呼吸暂停患者（50%）。10名（14%）儿童的舌扁桃体前后径>10 mm。既往行扁桃体切除术而无腭扁桃体的肥胖受试者中可测量舌扁桃体的患病率高于有腭扁桃体的受试者（分别为78%对22%；p<0.001），且舌扁桃体前后径>10 mm的患病率更高（90%对10%，p<0.001）。
肥胖儿童舌扁桃体增大的发生率很高，既往行扁桃体切除术的儿童患病率显著更高。增大的舌扁桃体可能在肥胖儿童阻塞性睡眠呼吸暂停的发病机制中起作用。
