Brodsky L, Moore L, Stanievich J
Department of Otolaryngology, State University of New York, Buffalo School of Medicine.
Laryngoscope. 1988 Oct;98(10):1055-60. doi: 10.1288/00005537-198810000-00006.
The role of specific bacteria in the pathogenesis of tonsillar hypertrophy in children in unknown. To determine the effect of specific bacteria on the presence and nature of tonsillar hypertrophy (measured both clinically and by tonsil weight), quantitative aerobic bacteriology was performed on 54 tonsil-core specimens from 54 children undergoing tonsillectomy for chronic tonsillitis and/or tonsillar hypertrophy. Twelve tonsil-core biopsies from 12 children with no history of tonsil disease served as controls. Haemophilus influenzae (HI), Streptococcus pyogenes (SP), Streptococcus pneumoniae (SPn), and Staphylococcus aureus (SA) were the most common microorganisms cultured from diseased tonsils. Few bacteria were cultured from the cores of controls. HI was cultured as the dominant aerobic bacteria in 15 of 54 tonsils (27%). For HI alone, the number of bacteria/gram tonsil showed a significant positive correlation to tonsil weight (p less than 0.05). Fourteen of 15 (94%) tonsils with HI were found in patients with clinical tonsillar hypertrophy, while only 6 of 10 patients (60%) with SP and SPn had tonsillar hypertrophy. Of the 38 tonsils removed for obstructive symptoms (clinical hypertrophy), 14 of 38 (37%) cultured HI as the dominant microorganisms, whereas only 6 of 38 (16%) cultured SP. Neither the type of HI (b vs. non-b) nor the presence of beta-lactamase production had a significant correlation to tonsil weight, bacterial load or the number of B- or T-cell subsets. The number of T-helper (Th), T-suppressor (Ts) and B-cells (per gram/tonsil) was markedly greater in all diseased tonsils than in controls. For both HI and SP the total number of bacteria/gram tonsil correlated positively to the number of Ts cells (p less than 0.003 and p less than 0.007, respectively). In patients with HI type b (HI-b), the tonsil weight correlated to an increase in Ts and B-cells (p less than 0.004 and p less than 0.007, respectively). An increased presence of the Ts and B-cells in the HI-b tonsils (and not in tonsils with HI non-b) suggests a differential response by the tonsil to these distinct but related bacteria. The above data strongly support an etiological role for HI in the pathogenesis of tonsillar hypertrophy in children. Alterations in the relationship between Th and Ts cells may affect normal B-cell function and be implicated in this phenomenon. Clinical implications for pathogenesis, antimicrobial therapy, and future directions for research are discussed.
特定细菌在儿童扁桃体肥大发病机制中的作用尚不清楚。为了确定特定细菌对扁桃体肥大的存在及性质（通过临床检查和扁桃体重量来衡量）的影响，对54例因慢性扁桃体炎和/或扁桃体肥大而接受扁桃体切除术的儿童的54个扁桃体核心标本进行了需氧菌定量培养。选取12例无扁桃体疾病史儿童的12个扁桃体核心活检标本作为对照。流感嗜血杆菌（HI）、化脓性链球菌（SP）、肺炎链球菌（SPn）和金黄色葡萄球菌（SA）是从患病扁桃体中培养出的最常见微生物。对照标本中培养出的细菌很少。在54个扁桃体中的15个（27%）中，HI被培养为优势需氧菌。仅就HI而言，每克扁桃体中的细菌数量与扁桃体重量呈显著正相关（p<0.05）。15个培养出HI的扁桃体中有14个（94%）见于有临床扁桃体肥大的患者，而培养出SP和SPn的10例患者中只有6例（60%）有扁桃体肥大。在因阻塞性症状（临床肥大）而切除的38个扁桃体中，38个中有14个（37%）培养出HI作为优势微生物，而38个中只有6个（16%）培养出SP。HI的类型（b型与非b型）以及β-内酰胺酶的产生与扁桃体重量、细菌载量或B细胞或T细胞亚群数量均无显著相关性。所有患病扁桃体中辅助性T细胞（Th）、抑制性T细胞（Ts）和B细胞（每克扁桃体）的数量均明显多于对照组。对于HI和SP，每克扁桃体中的细菌总数均与Ts细胞数量呈正相关（分别为p<0.003和p<0.007）。在感染b型HI（HI-b）的患者中，扁桃体重量与Ts细胞和B细胞数量的增加相关（分别为p<0.004和p<0.007）。HI-b扁桃体中Ts细胞和B细胞数量增加（而非非b型HI扁桃体）表明扁桃体对这些不同但相关细菌的反应存在差异。上述数据有力地支持了HI在儿童扁桃体肥大发病机制中的病因学作用。Th细胞和Ts细胞之间关系的改变可能影响正常B细胞功能，并与这一现象有关。文中讨论了发病机制、抗菌治疗的临床意义以及未来的研究方向。
