Cocuzza S, Marino S, Gulino A, Pustorino E, Murabito P, Maniaci A, Sabino L, Taibi R, Di Luca M, Falsaperla R, Campione G, Vecchio M, Pavone P
ENT Department of Otorhinolaryngology, University of Catania, Catania, Italy.
Eur Rev Med Pharmacol Sci. 2019 May;23(10):4110-4117. doi: 10.26355/eurrev_201905_17912.
PANDAS are known as the spectrum of autoimmune pathologies related to a previous or current infection by group A beta-hemolytic streptococcus (SBEGA), dealing with several neuropsychiatric manifestations that mainly affect pediatric age. The main features consist of behavioral disease or movement disease characterized by acute-onset, presenting especially through infant period or adolescence. Specific manifestations, occurring during the progression of the disease, are the presence of otorhinolaryngologic symptoms (ENT) and orofacial movement disorders associated with temporomandibular joint pain.
We enrolled 130 children (5-15 years) with a clinical diagnosis of PANDAS between 2012 and 2018. Participants were assessed using ENT specific parameters, PSG to examine respiratory disorders and conventional audiological evaluation. Descriptive and comparative statistical analyses were performed with a control group of 51 healthy patients.
The prevalence of ENT symptoms associated was significantly detected in 88 patients of 130 in Group A (relative frequency (%) 67.6; p=0.041) and in 51 patients of 130 in the control Group B (relative frequency (%) 39.2; p=0.063). In relation to prevalence of SDB, 54 subjects have presented nocturnal respiratory obstructive symptoms from mild to severe (relative frequency (%) 61.3; p=0.033) vs. 20 patients of Group B (relative frequency (%) 39.2; p=0.055). The obstructive severity average type was correlated to the consensual adenotonsillar development (size 3-4), (relative frequency (%) 45.4; p=0.047). The audiological deficits found were mostly of transmissive type with OME correlated and linked to the presence of occasional episodes of AOM. The four PANDAS patients who presented orobuccal dystonia (relative frequency (%) 4.54; p=0.091) achieved an improvement of the algic symptoms through the exercises of self-rehabilitation.
Findings from our study show that respiratory diseases, characterizing a group of patients with pandas, are the direct consequences of the malformed or hypertrophic condition and suggesting in these conditions surgical therapy as an approaching tool.
儿童自身免疫性神经精神性疾病相关链球菌感染（PANDAS）是一种与先前或当前A组β溶血性链球菌（SBEGA）感染相关的自身免疫性疾病谱，涉及多种主要影响儿童期的神经精神表现。其主要特征包括以急性发作为特点的行为疾病或运动疾病，尤其在婴儿期或青春期出现。在疾病进展过程中出现的特定表现是存在耳鼻喉科症状（ENT）以及与颞下颌关节疼痛相关的口面部运动障碍。
我们纳入了2012年至2018年间临床诊断为PANDAS的130名儿童（5 - 15岁）。使用耳鼻喉科特定参数、多导睡眠图（PSG）检查呼吸障碍以及常规听力评估对参与者进行评估。对51名健康患者组成的对照组进行了描述性和比较性统计分析。
A组130名患者中有88名显著检测到相关耳鼻喉科症状的患病率（相对频率（%）67.6；p = 0.041），B组对照组130名患者中有51名（相对频率（%）39.2；p = 0.063）。关于睡眠呼吸障碍（SDB）的患病率，54名受试者出现了从轻度到重度的夜间呼吸阻塞症状（相对频率（%）61.3；p = 0.033），而B组有20名患者（相对频率（%）39.2；p = 0.055）。阻塞严重程度的平均类型与腺样体扁桃体的一致性发育（大小3 - 4）相关（相对频率（%）45.4；p = 0.047）。发现的听力缺陷大多为传导性类型，中耳炎（OME）与偶发性急性中耳炎（AOM）相关并与之有关。出现口颊肌张力障碍的4名PANDAS患者（相对频率（%）4.54；p = 0.091）通过自我康复锻炼使疼痛症状得到改善。
我们的研究结果表明，呼吸系统疾病是一组PANDAS患者的特征，是畸形或肥大状况的直接后果，并提示在这些情况下手术治疗是一种可行的方法。
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