Muhereza Brian, Ndoleriire Christopher, Ndeezi Grace, Matsiko Sedrack, Nabawanga Stella, Esther Nakasagga
Department of Ear, Nose, and Throat, School of Medicine, College of Health Sciences, Makerere University, Uganda.
Department of Ear, Nose, and Throat, School of Medicine, College of Health Sciences, Makerere University, Uganda.
Pediatr Neonatol. 2025 Jul 9. doi: 10.1016/j.pedneo.2025.01.017.
This unmatched case-control study compared the mean frequency of vaso-occlusive crisis in sickle cell disease patients aged 2-17 years with adenotonsillar hypertrophy (ATH) and those without at Mulago Hospital, Kampala, Central Uganda.
From September to December 2022, sickle cell disease patients aged 2-17 years were examined using headlight illumination, a tongue depressor, and a post-nasal x-ray to diagnose adenotonsillar hypertrophy. Social-demographic characteristics, medical history, and physical examination findings were recorded using a data collection form. Patients who had bone pain requiring hospitalization in the previous 6 months were regarded as having a vaso-occlusive crisis. Those with a diagnosis of ATH (cases) were compared to those without (controls). Data were collected and managed using an open data kit (ODK) and analysed using STATA version 16. A T-test was used to compare the mean frequency of vaso-occlusive crisis between Cases and Controls.
There was a significant difference in the mean frequency of painful vaso-occlusive crises suffered in the previous 6 months between cases and controls (p value = 0.018). Age of 15-18 years [OR(CI):1.56, AOR:2.59; p = 0.047], females [OR(CI):1.68, AOR: 2.35; p = 0.003], snoring [OR(CI):12.01, AOR:8.4; p < 0.0001], and children who predominately breathe through the mouth [OR(CI):12.92, AOR:5.14; p = 0.001] were all associated with increased odds of adenotonsillar hypertrophy. Among disease-modifying factors, patients who were taking hydroxyurea [OR(CI): 2.16, AOR: 2.33; p = 0.027] had higher odds of adenotonsillar hypertrophy.
Children with sickle cell disease and adenotonsillar hypertrophy are at risk of suffering more pain vaso-occlusive crises compared to their healthy counterparts. The presence of obstructive adenotonsillar hypertrophy in children with sickle cell disease increases sickle cell morbidity, so more attention to these children through routine screening, diagnosis, and timely therapeutic intervention could reduce the morbidity.
本非匹配病例对照研究比较了乌干达中部坎帕拉穆拉戈医院2至17岁患有腺样体扁桃体肥大（ATH）的镰状细胞病患者与未患该病患者血管闭塞性危机的平均发生频率。
2022年9月至12月，对2至17岁的镰状细胞病患者使用头灯照明、压舌板和鼻后X光检查来诊断腺样体扁桃体肥大。使用数据收集表记录社会人口学特征、病史和体格检查结果。过去6个月内有需要住院治疗的骨痛患者被视为发生了血管闭塞性危机。将诊断为ATH的患者（病例）与未患该病的患者（对照）进行比较。使用开放数据工具包（ODK）收集和管理数据，并使用STATA 16版本进行分析。采用T检验比较病例组和对照组血管闭塞性危机的平均发生频率。
病例组和对照组在过去6个月内发生疼痛性血管闭塞性危机的平均频率存在显著差异（p值 = 0.018）。15至18岁[比值比（置信区间）：1.56，调整后比值比：2.59；p = 0.047]、女性[比值比（置信区间）：1.68，调整后比值比：2.35；p = 0.003]、打鼾[比值比（置信区间）：12.01，调整后比值比：8.4；p < 0.0001]以及主要通过口腔呼吸的儿童[比值比（置信区间）：12.92，调整后比值比：5.14；p = 0.001]均与腺样体扁桃体肥大的几率增加相关。在疾病修饰因素中，服用羟基脲的患者[比值比（置信区间）：2.16，调整后比值比：2.33；p = 0.027]患腺样体扁桃体肥大的几率更高。
与健康儿童相比，患有镰状细胞病和腺样体扁桃体肥大的儿童发生更多疼痛性血管闭塞性危机的风险更高。镰状细胞病患儿存在阻塞性腺样体扁桃体肥大增加了镰状细胞病的发病率，因此通过常规筛查、诊断和及时的治疗干预对这些儿童给予更多关注可以降低发病率。
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