腺样体切除术后阻塞型睡眠呼吸暂停低通气综合征患儿骨龄和血清骨钙素的变化

Fluctuation of bone age and serum osteocalcin in children with obstructive sleep apnea hypopnea syndrome before and after adenotonsillectomy

摘要:

目的 探讨腺样体切除术对阻塞型睡眠呼吸暂停低通气综合征（OSAHS）患儿术后气道阻塞改善、骨龄及骨钙素水平改变情况。方法 选取2017年10月—2019年3月徐州医科大学附属淮安医院就诊的OSAHS患儿85例。根据呼吸暂停低通气指数（AHI）分为轻度组19例，中度组46例，重度组20例；另纳入30例健康儿童作为对照组。监测腺样体切除术术前（T₀）和术后6月（T₁）OSAHS患儿AHI、最低血氧饱和度（MiniSO₂）、血氧饱和度下降指数（ODI4）、血氧饱和度<90%百分比（TS90%）、Epworth嗜睡度量表（ESS）、骨钙素及骨龄改变情况。结果 T₁时组内比较，OSAHS患儿AHI、ODI4、TS90%和ESS降低（P <0.05），骨钙素水平升高（P <0.05），△_{骨龄-实际年龄}降低（P <0.05）。亚组分析可见除轻度组MiniSO₂外，各组OSAHS患儿的呼吸指标均改善（P <0.05）。T₀时轻度组、中度组、重度组骨钙素水平均低于对照组（P <0.05），而△_{骨龄-实际年龄}水平高于对照组（P <0.05）。相关性分析提示△骨钙素与△AHI、△ODI4和△TS90%（r =-0.654、-0.706和-0.622，均P <0.05）呈负相关。结论 腺样体切除术可以改善OSAHS患者气道阻塞症状和骨骼发育情况。

Abstract:

Objective To evaluate the improvement of airway obstruction and fluctuation of bone age and serum osteocalcin in children with obstructive sleep apnea hypopnea syndrome before and after adenotonsillectomy.Methods Eighty-five OSAHS children were enrolled in this study and divided into three group based on apnea-hypopnea index (AHI): mild group (n = 19), moderate group (n = 46) and severe group (n = 20). Thirty healthy children were enrolled as control group. It was measured that AHI, minimal saturation O₂ (MiniSO₂), oxygen desaturation index (ODI4), TS90%, Epworth Sleepiness Scale (ESS), osteocalcin, and bone age in two time points (T₀: before surgery, T₁: 6 months after surgery).Results Intragroup analysis showed the levels of AHI, ODI4, TS90%, and ESS of OSAHS children were decreased at T₁ (P < 0.05). The levels of osteocalcin were increased and △bone-actual age were decreased at T₁ (P < 0.05). Subgroup analysis showed that all the respiratory index, except MiniSO₂ of mild subgroup, were improved after surgery (P < 0.05). Intergroup analysis suggested that the levels of osteocalcin of OSAHS children were lower than those of control children (P < 0.05), while △bone-actual age were higher than those of control children (P < 0.05). Correlation analysis showed that △osteocalcin was negatively related with △AHI (r = -0.654, P < 0.05), △ODI4 (r = -0.706, P < 0.05) and △TS90% (r = -0.622, P < 0.05).Conclusion Adenotonsillectomy may significantly improve the airway obstruction and skeleton growth of OSAHS children.