儿童扁桃体肥大伴咽喉反流的临床特征及反流量表效能分析OA

OBJECTIVE To investigate the clinical characteristics of tonsillar hypertrophy associated with laryngopharyngeal reflux(LPR)in pediatric patients,and to evaluate the predictive value of laryngopharyngeal reflux finding score(RFS)and reflux symptom index(RSI)for LPR.METHODS A total of 86 pediatric patients diagnosed with obstructive sleep apnea(OSA)were recruited from April 2020 to October 2021 in the Department of Otolaryngology Head and Neck Surgery,Fuyang People's Hospital.All cases were complicated with tonsillar hypertrophy,and preoperative evaluations of RFS and RSI were performed in all children.The tonsil tissue specimens were routinely processed for paraffin sectioning and stained with hematoxylin and eosin,as well as immunohistochemical staining for pepsin.Based on the results of pepsin expression,the specificity and sensitivity of RFS and RSI in predicting LPR were evaluated.RESULTS Pepsin expression was observed in 59 specimens,with an overall positive rate of 68.60%.Among them,there were 14 strongly positive cases(16.28%,14/86),19 positive cases(22.09%,19/86)and 26 weakly positive cases(30.23%,26/86).The positive rate of LPR was 73.91%(51/69)in children with adenoid hypertrophy,which was significantly higher than that in children with normal adenoids(47.06%,8/17).The difference was statistically significant(χ²=4.57,P<0.05).The average age in the pepsin expression positive group was lower than that in the negative group[(7.25±1.87)years vs.(8.37±2.34)years)],and the difference was statistically significant(t=2.35,P<0.05).There were 9 cases(10.47%)with RSI>13,38 cases(44.19%)with RFS>7,and 3 cases(3.49%)with both scores positive.The degree of tonsillar hypertrophy was positively correlated with the intensity of pepsin expression(r=0.57,P<0.01).Defining the positive pepsin expression as diagnostic criteria of LPR,the specificity of RFS and RSI was 76.32%and 88.89%,while the sensitivity was 49.15%and 13.56%.CONCLUSION Pediatric tonsillar hypertrophy is correlated with LPR,which is prevalent in affected children,and contributes greatly to the progression of tonsillar hypertrophy.RSI and RFS show high specificity for predicting LPR.Accordingly,positive findings should prompt clinicians to suspect concurrent LPR in pediatric patients.However,due to the low sensitivity,these scales are not recommended for evaluating LPR in children.