Semberova J, Rychly B, Hanzelova J, Jakubikova J
Department of Clinical Immunology and Allergology, Children's University Hospital, Bratislava, Slovakia.
Bratisl Lek Listy. 2013;114(3):140-4. doi: 10.4149/bll_2013_031.
To analyze the immune status in situ of tonsils of patients with recurrent tonsillitis (RT) and idiopathic tonsillar hypertrophy (ITH) with the aim to discuss the indications of tonsillectomy (TE) and tonsillotomy (TT) in young children.
The histological and immunohistological study of tonsillar tissue of RT and ITH in correlation with immunological parameters in peripheral blood in 13 patients with RT and 16 patients with ITH.
In the RT group, we found a higher degree of fibrosis with a higher density of memory lymphocytes (CD45R0+), B-lymphocytes (CD20+) and cytotoxic T-lymphocytes (CD8+) in surface epithelium of tonsils compared to the ITH group (NS). The density of immunoglobulin IgG in the crypt epithelium in RT was significantly higher than in the ITH group (p = 0.041). We also measured a higher sera concentration of immunoglobulines (IgG, IgM, IgA) and TNF-α in RT compared to the ITH group (NS) and TH-1 immune response in tonsillar tissue based on differences between local cytokine concentration TNF-α and IL-4.
RT has a higher inflammatory reaction in tonsillar tissue as a result of persistent bacterial antigenic stimulation. In patients with RT, the tonsillectomy might be the only option for surgical treatment. In patients with ITH with mild symptoms, the tonsillotomy should be preferred (Tab. 3, Ref. 24).
分析复发性扁桃体炎（RT）和特发性扁桃体肥大（ITH）患者扁桃体的原位免疫状态，旨在探讨小儿扁桃体切除术（TE）和扁桃体部分切除术（TT）的适应证。
对13例RT患者和16例ITH患者的扁桃体组织进行组织学和免疫组织学研究，并与外周血免疫参数进行相关性分析。
与ITH组相比，RT组扁桃体表面上皮纤维化程度更高，记忆淋巴细胞（CD45R0+）、B淋巴细胞（CD20+）和细胞毒性T淋巴细胞（CD8+）密度更高（无统计学差异）。RT组隐窝上皮中免疫球蛋白IgG密度显著高于ITH组（p = 0.041）。与ITH组相比，RT组血清免疫球蛋白（IgG、IgM、IgA）和TNF-α浓度也更高（无统计学差异），且基于局部细胞因子浓度TNF-α和IL-4的差异，RT组扁桃体组织存在TH-1免疫反应。
由于持续的细菌抗原刺激，RT患者扁桃体组织炎症反应更强。对于RT患者，扁桃体切除术可能是唯一的手术治疗选择。对于症状较轻的ITH患者，应首选扁桃体部分切除术（表3，参考文献24）。
