Chuang Hai-Hua, Huang Chung-Guei, Chuang Li-Pang, Huang Yu-Shu, Chen Ning-Hung, Li Hsueh-Yu, Fang Tuan-Jen, Hsu Jen-Fu, Lai Hsin-Chih, Chen Jau-Yuan, Lee Li-Ang
Department of Family Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan.
Department of Family Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
J Clin Med. 2020 Feb 20;9(2):579. doi: 10.3390/jcm9020579.
Both obstructive sleep apnea (OSA) and obesity are major health issues that contribute to increased systemic inflammation in children. To date, adenotonsillectomy (AT) is still the first-line treatment for childhood OSA. However, the relationships among and predictive values of obesity, inflammation, and OSA severity have not been comprehensively investigated. This prospective study investigated body mass index (BMI), serum inflammatory markers, and OSA severity before and after AT in 60 pediatric patients with OSA. At baseline, differences in levels of interleukin-6, interleukin-9, basic fibroblast growth factor, platelet-derived growth factor-BB, as well as regulated on activation, normal T cell expressed and secreted (RANTES) were significant among the various weight status and OSA severity subgroups. After 3 months postoperatively, the differences in these inflammatory markers diminished along with a decrease in OSA severity while obesity persisted. The rate of surgical cure (defined as postoperative obstructive apnea-hypopnea index < 2.0 and obstructive apnea index < 1.0) was 62%. Multivariate analysis revealed that age, BMI z-score, granulocyte-macrophage colony-stimulating factor, monocyte chemotactic protein-1, and RANTES independently predicted surgical cure. Despite the significant reductions in inflammatory markers and OSA severity after AT, an inter-dependent relationship between obesity and OSA persisted. In addition to age and BMI, several inflammatory markers helped to precisely predict surgical cure.
阻塞性睡眠呼吸暂停（OSA）和肥胖都是导致儿童全身炎症增加的主要健康问题。迄今为止，腺样体扁桃体切除术（AT）仍是儿童OSA的一线治疗方法。然而，肥胖、炎症和OSA严重程度之间的关系及其预测价值尚未得到全面研究。这项前瞻性研究调查了60例OSA患儿在AT前后的体重指数（BMI）、血清炎症标志物和OSA严重程度。在基线时，不同体重状况和OSA严重程度亚组之间，白细胞介素-6、白细胞介素-9、碱性成纤维细胞生长因子、血小板衍生生长因子-BB以及活化调节正常T细胞表达和分泌因子（RANTES）水平存在显著差异。术后3个月，随着OSA严重程度的降低，这些炎症标志物的差异减小，但肥胖仍然存在。手术治愈率（定义为术后阻塞性呼吸暂停低通气指数<2.0且阻塞性呼吸暂停指数<1.0）为62%。多变量分析显示，年龄、BMI z评分、粒细胞巨噬细胞集落刺激因子、单核细胞趋化蛋白-1和RANTES可独立预测手术治愈情况。尽管AT后炎症标志物和OSA严重程度显著降低，但肥胖与OSA之间的相互依存关系仍然存在。除年龄和BMI外，几种炎症标志物有助于准确预测手术治愈情况。
