天津医药

天津医药 ›› 2019, Vol. 47 ›› Issue (3): 265-268.doi: 10.11958/20181682

• 临床研究 • 上一篇    下一篇

嗜酸性粒细胞在腺样体肥大患儿诊治中的临床价值

张奇雪，曹媛，张桂敏，赵秀娟，阮宏莹，郑永哲，杜建群，鲁宏华，林鹏   

  1. 1天津医科大学一中心临床学院（邮编300192）；2天津市第一中心医院耳鼻咽喉头颈外科，天津市耳鼻咽喉科研究所；3天津医科大学基础医学院细胞生物学系
  • 收稿日期:2018-11-06 修回日期:2019-02-03 出版日期:2019-03-15 发布日期:2019-04-24
  • 通讯作者: 张奇雪 E-mail:zqx13132151305@163.com

The clinical value of eosinophils in the diagnosis and treatment of children with adenoid hypertrophy

ZHANG Qi-xue,CAO Yuan,ZHANG Gui-min,ZHAO Xiu-juan,RUAN Hong-ying,ZHENG Yong-zhe,DU Jian-qun,LU Hong-hua,LIN Peng   

  1. 1 The First Center Clinic College, Tianjin Medical University, Tianjin 300192, China; 2 Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Center Hospital, Otorhinolaryngology Institute of Tianjin;3 Department of Cell Biology, College of Basic Medical, Tianjin Medical University
  • Received:2018-11-06 Revised:2019-02-03 Published:2019-03-15 Online:2019-04-24
  • Contact: Qi-Xue ZHANG E-mail:zqx13132151305@163.com

PDF (PC)

4019

摘要： 目的 探讨嗜酸性粒细胞（EOS）在腺样体肥大患儿组织和外周血中的分布水平及与变应因素的相关性。方法 选择2017年10月—2018年7月于天津市第一中心医院耳鼻咽喉头颈外科行腺样体切除手术的患儿为研究对象。将112例患儿分为单纯腺样体肥大（AH）组62例，腺样体肥大伴变态反应性鼻炎（AH+AR）组50例。高倍镜下观察苏木精-伊红（HE）染色的组织切片中EOS数量，抽取外周血检验EOS百分比，对所有患儿进行血清特异性IgE检测及视觉模拟量表（VAS）评分，分析组织和外周血中EOS水平差异。绘制受试者工作特征（ROC）曲线，评价组织和外周血EOS水平对AH+AR的诊断价值。结果 在腺样体肥大患儿中，AH+AR组EOS明显高于AH组（P＜0.05），不同过敏原等级EOS水平差异无统计学意义（P＞0.05）。在外周血中，伴重度变态反应性鼻炎组EOS水平明显高于轻度变态反应性鼻炎组（P＜0.05），重度与中度、中度与轻度组间差异无统计学意义（P＞0.05）；在组织中，变态反应性鼻炎症状愈严重，EOS 水平愈高（均 P＜0.05）。根据 ROC 曲线，分别计算曲线下面积（AUC）：外周血（AUC=0.791，95%CI：0.705~0.878，P＜0.001），截断点（cut-off 值）为 2.6%，此时敏感度为 70.0%，特异度为 74.2%；组织（AUC=0.843，95%CI：0.765~0.920，P＜0.001），cut-off值为3/10个视野，此时敏感度为76.0%，特异度为80.6%。结论 血清特异性IgE检测阳性的腺样体肥大患儿中腺样体组织和外周血EOS的水平增高，提示AH患儿的病因中有变应因素存在。组织中EOS水平较外周血对于变应因素的鉴别更具诊断意义。

关键词: 超敏反应, 嗜酸细胞, 组织, 外周血, 腺样体肥大

Abstract: Objective To investigate the levels of eosinophils (EOS) in peripheral blood and tissues of children with adenoid hypertrophy, and its correlation with allergic factors. Methods A total of 112 children underwent adenoidectomy in the department of otorhinolaryngology, head and neck surgery of Tianjin First Center Hospital from October 2017 to July 2018 were selected as the study objects. These children were divided into two study groups: adenoid hypertrophy only (AH,n=62) group and adenoid hypertrophy with allergic rhinitis (AH+AR, n=50) group. The number of EOS in tissue sections stained with hematoxylin-eosin (HE) was observed under high power microscope. The percentage of EOS in peripheral blood was detected. In addition, the serum specific IgE detection and visual analogue scales (VAS) were performed in all children,and the differences of the levels of EOS in tissues and peripheral blood were analyzed. The receiver operating characteristic(ROC) curve was drawn to analyze the diagnostic value of the EOS levels in tissues and peripheral blood for allergic factors in children with AH+AR. Results The EOS level was significantly higher in AH + AR group than that in AH group (P＜ 0.05). There were no significant differences in EOS levels between different levels of allergen (P＞0.05). The EOS level in peripheral blood was significantly higher in patients with severe allergic rhinitis than that of patients with mild allergic rhinitis (P＜0.05). There were no significant differences in the EOS levels between severe and moderate rhinitis, moderate and mild rhinitis (P＞0.05). In tissues, the more severe the symptoms of allergic rhinitis are, the higher the level of EOS is(P＜0.05). According to the ROC curve, the area under the curve (AUC): peripheral blood was 0.791 (95%CI: 0.705-0.878，P＜0.001), the cut-off value was 2.60%, and the sensitivity was 70.0%, the specificity was 74.2%; and in tissue AUC was0.843 (95%CI: 0.765-0.920, P<0.001), the cut-off value was 3/10 sections, and the sensitivity was 76.0% and the specificity was 80.6%. Conclusion The EOS levels in adenoid tissue and peripheral blood are increased in children with positive serum specific IgE, suggesting that there are allergic factors are in the etiology of AH. The EOS level in tissues is more important for the differential diagnosis of allergic factors.

Key words: hypersensitivity, eosinophils, tissues, peripheral blood, adenoid hypertrophy