Department of Otolaryngology-Head and Neck Surgery, The Affiliated Children Hospital of Xi'an Jiao Tong University, Xi'an, China.
Department of Otolaryngology-Head and Neck Surgery, Shaanxi Provincial Hospital of Chinese Medicine, Xi'an, China.
Int Arch Allergy Immunol. 2023;184(7):634-642. doi: 10.1159/000528445. Epub 2023 Mar 30.
Adenoidectomy is a common procedure in children who have adenoid hypertrophy (AH), but anesthesia risks should be considered. We proposed a novel classification system for adenoids based on their appearance. Additionally, we explored whether the novel classification of adenoids correlates with the response to therapy and thus might be helpful for further treatment recommendations.
We used fiberoptic nasal endoscopy to determine the degree and appearance of AH. Obstructive Sleep Apnea Questionnaire (OSA-18) was used to assess the quality of life of children with AH. The adenoids were divided into three types: edematous type, common type, and fibrous type. In adenoid tissues, the eosinophils were counted. Immunohistochemistry and Western blot were done to determine the expression of CysLTR1, CysLTR2, CGR-α, and CGR-β in different types of adenoids.
70.67% (106/150) of AH patients presented with allergic rhinitis (AR), and of them, 68% (72/106) of adenoids were the edematous type. The expressions of CGR-α, CGR-β, and eosinophil count were higher in the edematous compared with the common and fibrous types. The expression of the leukotriene receptor was similar in all types. Upon montelukast combined with nasal glucocorticoid therapy, improvement of OSA-18 scores and AH grade was significantly compared to montelukast monotherapy for edematous type. There was not any statistically significant difference between the scores upon montelukast combined with nasal glucocorticoid and montelukast monotherapy for common and fibrous type. We observed a positive correlation between eosinophil count in the blood and in the adenoid tissue.
AR was the risk factor for the development of edematous AH. All subtypes of AH responded to montelukast, while there was an additional effect of nasal glucocorticoid in the edematous type. A combination therapy of nasal glucocorticoid with leukotriene receptor antagonist can be recommended for AH patients with AR, patients with edematous adenoids, and/or patients with increased eosinophils in blood routine.
腺样体切除术是治疗腺样体肥大（AH）儿童的常见手术，但应考虑麻醉风险。我们提出了一种基于腺样体外观的新型分类系统。此外，我们还探讨了新型腺样体分类是否与治疗反应相关，从而可能有助于进一步的治疗建议。
我们使用纤维鼻内窥镜确定 AH 的程度和外观。阻塞性睡眠呼吸暂停问卷（OSA-18）用于评估 AH 患儿的生活质量。腺样体分为三种类型：水肿型、普通型和纤维型。在腺样体组织中计算嗜酸性粒细胞计数。免疫组织化学和 Western blot 用于确定不同类型腺样体中 CysLTR1、CysLTR2、CGR-α 和 CGR-β 的表达。
70.67%（106/150）的 AH 患者合并变应性鼻炎（AR），其中 68%（72/106）的腺样体为水肿型。与普通型和纤维型相比，水肿型腺样体中 CGR-α、CGR-β 的表达和嗜酸性粒细胞计数较高。白细胞介素受体的表达在所有类型中相似。与孟鲁司特单药治疗相比，孟鲁司特联合鼻用糖皮质激素治疗对水肿型的 OSA-18 评分和 AH 分级改善更明显。孟鲁司特联合鼻用糖皮质激素与孟鲁司特单药治疗在普通型和纤维型之间的评分无统计学差异。我们观察到血中和腺样体组织中嗜酸性粒细胞计数之间存在正相关。
AR 是水肿型 AH 发生的危险因素。所有亚型的 AH 均对孟鲁司特反应良好，而在水肿型中鼻用糖皮质激素有额外作用。对于 AR 患者、水肿型腺样体患者和/或血常规嗜酸性粒细胞增多的 AH 患者，推荐鼻用糖皮质激素与白三烯受体拮抗剂联合治疗。
