McCormick David P, Grady James J, Diego Alejandro, Matalon Reuben, Revai Krystal, Patel Janak A, Han Yimei, Chonmaitree Tasnee
Division of General Academic Pediatrics, Department of Pediatrics, The University of Texas Medical Branch at Galveston, TX, United States.
Int J Pediatr Otorhinolaryngol. 2011 May;75(5):708-12. doi: 10.1016/j.ijporl.2011.02.021. Epub 2011 Mar 26.
We have previously shown an association between polymorphisms of proinflammatory cytokine genes and susceptibility to upper respiratory tract infection and acute otitis media. It has not been known whether polymorphisms or risk factors are associated with the severity of acute otitis media.
To evaluate the influences of proinflammatory cytokine gene polymorphisms and other risk factors on severity of acute otitis media following upper respiratory tract infection.
In a prospective, longitudinal study, children aged 6-35 months were followed for one year for occurrences of upper respiratory tract infection and acute otitis media. Children were studied for TNFα(-308), interleukin (IL)-6(-174) and IL-1β(+3953) polymorphisms, taking into account age, gender, race, family history of otitis, tobacco smoke exposure, breast feeding, day of upper respiratory tract infection at the time of diagnosis and pneumococcal vaccine status. Symptoms and signs of acute otitis media were graded according to a validated scale. The association between acute otitis media clinical severity, polymorphic genotypes, and risk factors were analyzed using statistical models that account for multiple episodes of acute otitis media per child.
A total of 295 episodes of acute otitis media in 128 subjects was included. More severe acute otitis media symptoms were associated with young age (P=0.01), family history of acute otitis media (P=0.002), tobacco smoke exposure (P=0.008), and early diagnosis of otitis after onset of upper respiratory tract infection (P=0.02). Among children with a bulging or perforated tympanic membrane (206 episodes, 104 subjects), those who had the IL-1 β(+3953) polymorphism, experienced higher symptom scores (P<0.02).
This is the first report of the association between risk factors and acute otitis media severity. Risk factors such as tobacco smoke exposure and a positive family history appear to be more significantly associated with acute otitis media severity than proinflammatory gene polymorphisms. Clinical severity may be an important factor contributing to the incidence and costs of acute otitis media, because children with more severe symptoms might be more likely to be brought for a medical visit, receive a diagnosis of acute otitis media, and be prescribed an antibiotic.
我们之前已经表明促炎细胞因子基因多态性与上呼吸道感染及急性中耳炎易感性之间存在关联。目前尚不清楚多态性或危险因素是否与急性中耳炎的严重程度相关。
评估促炎细胞因子基因多态性及其他危险因素对上呼吸道感染后急性中耳炎严重程度的影响。
在一项前瞻性纵向研究中，对6至35个月大的儿童进行为期一年的随访，观察上呼吸道感染和急性中耳炎的发病情况。研究儿童的肿瘤坏死因子α（TNFα）（-308）、白细胞介素（IL）-6（-174）和IL-1β（+3953）多态性，同时考虑年龄、性别、种族、中耳炎家族史、烟草烟雾暴露、母乳喂养、诊断时上呼吸道感染的天数及肺炎球菌疫苗接种情况。根据有效量表对急性中耳炎的症状和体征进行分级。使用考虑每个儿童多次急性中耳炎发作情况的统计模型分析急性中耳炎临床严重程度、多态基因型和危险因素之间的关联。
共纳入128名受试者的295次急性中耳炎发作。更严重的急性中耳炎症状与年龄小（P=0.01）、急性中耳炎家族史（P=0.002）、烟草烟雾暴露（P=0.008）以及上呼吸道感染发作后中耳炎的早期诊断（P=0.02）相关。在鼓膜膨出或穿孔的儿童（206次发作，104名受试者）中，携带IL-1β（+3953）多态性的儿童症状评分更高（P<0.02）。
这是关于危险因素与急性中耳炎严重程度之间关联的首次报告。烟草烟雾暴露和阳性家族史等危险因素似乎比促炎基因多态性与急性中耳炎严重程度的关联更为显著。临床严重程度可能是导致急性中耳炎发病率和费用的一个重要因素，因为症状更严重的儿童可能更有可能就医、被诊断为急性中耳炎并被开具抗生素。
