| Background Adenoid hypertrophy is a common disease in otolaryngology,usually occurring in children,with sleep snoring,open-mouth breathing,nasal obstruction and other symptoms as the main clinical manifestations,but also can cause secretory otitis media,chronic rhinosinusitis and other complications.The pathogenesis of adenoid hypertrophy is complicated,which is related to inflammatory reaction,immune regulation disorder,antibiotic abuse,allergy and genetic factors.Neutrophils/lymphocyte ratio(NLR),platelet/lymphocyte ratio(PLR),monocyte/lymphocyte ratio(MLR),platelet distribution width(PDW),mean platelet volume(MPV)and systemic immune inflammation index(SII)as peripheral blood inflammatory indexes that are simple and easy to test,and draw more and more attention,they may be closely related to the occurrence and development of adenoid hypertrophy.At present,endoscopic plasma adenoidectomy is the main treatment for pathological adenoid hypertrophy in children.However,surgery is invasive,and postoperative complications such as bleeding and infection will inevitably occur.Timely and accurate application of antibiotics is of great importance in the treatment and prevention of adenoid postoperative complications.Therefore,this research through the determination of expression level of peripheral blood inflammatory indexes such as NLR,PLR,SII and so on in children with adenoid hypertrophy,analyze the bacterial community characteristics and drug sensitivity results of nasopharyngeal secretions in children with different degrees of pathological adenoid hypertrophy,providing new ideas for the diagnosis of adenoid hypertrophy in children and the treatment and prevention of postoperative complications.Purpose 1.Study on the expression changes of peripheral blood inflammatory indexes such as NLR,PLR,SII and so on in children with adenoid hypertrophy,to discuss the correlation between peripheral blood inflammatory indexes and adenoid hypertrophy and its degree in children.2.To analyze the differences of bacterial flora and the drug sensitivity of nasopharyngeal secretions in children with different degrees of pathological adenoid hypertrophy,it has important reference significance to guide the postoperative standard selection of antibiotics in children with adenoid hypertrophy.Methods 1.Experimental group: there were 300 children with pathological adenoid hypertrophy,including 139 cases with adenoid Ⅲ degree hypertrophy and 161 cases with adenoid Ⅳ degree hypertrophy;Control group: 100 children admitted to hospital for reasons other than adenoid hypertrophy.2.Gender,age,height,weight and peripheral blood inflammatory indexes NLR,PLR,MLR,PDW,MPV,SII of the children were recorded;The nasopharyngeal secretions of the children with pathological adenoid hypertrophy were sent for bacterial culture and drug sensitivity test.3.The software SPSS 25.0 was used for statistical analysis.The general datas and peripheral blood inflammation indexes of Ⅲ degree hypertrophy group,Ⅳ degree hypertrophy group and control group were compared,and the differences in the bacterial distribution of nasopharyngeal secretions of Ⅲ degree hypertrophy group andⅣ degree hypertrophy group were compared.Results 1.There were no significant differences in gender,age and body mass index(BMI)between control group,Ⅲ degree hypertrophy group and Ⅳ degree hypertrophy group(P>0.05).2.The levels of NLR,PLR,PDW,MPV and SII in Ⅲ degree hypertrophy group and Ⅳdegree hypertrophy group were higher than those in control group,and the differences were statistically significant(P< 0.05),and Ⅳ degree hypertrophy group> Ⅲ degree hypertrophy group,the difference was statistically significant(P< 0.05);There was no significant difference in MLR level among the three groups(P > 0.05).3.The levels of NLR,PLR,PDW,MPV and SII were positively correlated with the degree of adenoid hypertrophy in children.However,MLR level had no correlation with adenoid hypertrophy in children.4.The AUC of NLR,PLR,PDW,MPV and SII were 0.590,0.611,0.584,0.603 and 0.615,P< 0.05,indicating that NLR,PLR,PDW,MPV and SII have diagnostic and predictive value for adenoid hypertrophy in children.However,the AUC of MLR is 0.486,which has no predictive value for the diagnosis of adenoid hypertrophy in children.5.Haemophilus influenzae,Staphylococcus aureus and Streptococcus pneumoniae were the main pathogenic bacteria in nasopharyngeal secretions of children with adenoid hypertrophy.There was no significant difference in the flora distribution of nasopharyngeal secretions betwee Ⅲ degree hypertrophy group and Ⅳ degree hypertrophy group(P > 0.05).6.The drug resistance rates of Haemophilus influenzae to cotrimoxazole,ampicillin,cefaclor and cefuroxime were 95.56%,93.33%,91.11% and 88.89%;The drug resistance rates of Staphylococcus aureus to penicillin,erythromycin and clindamycin were 90.00%,65.00% and 62.50%;The drug resistance rates of Streptococcus pneumoniae to erythromycin and clindamycin were 100%,and that to tetracycline was 84.00%.Conclusion 1.The levels of peripheral blood inflammatory indexes in children with adenoid hypertrophy increased to varying degrees,suggesting that adenoid hypertrophy may have chronic inflammatory reactions.Moreover,with the increase of the degree of adenoid hypertrophy in children,the level of peripheral blood inflammation indexes shows an increasing trend,so they can be used as preliminary screening indexes for the diagnosis and severity prediction of adenoid hypertrophy in children.2.Haemophilus influenzae,Staphylococcus aureus and Streptococcus pneumoniae showed joint resistance to commonly used antibiotics.Therefore,it is necessary to strengthen the tracking of bacterial culture and drug sensitivity test results in clinical practice,and adjust medication regimen in time,so as to reduce the generation of drug-resistant bacteria.3.For children with pathological adenoid hypertrophy of different degrees,unified medication standards can be formulated for the prevention and treatment of postoperative complications with clinical empirical medication,without the need for differentiated medication. |
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