Treg In Children With Obstructive Sleep Apnea Syndrome And The Relationship With Allergic Rhinitis

Objectives:obstructive sleep apnea hyponea syndrome(OSAHS)in children usually caused by structure or functional abnormalities,or by the obstruction of the upper airway.The most common cause of OSA in children is tonsil or/and adenoid hypertrophy.Adenoid tissue in the mucosa-associated lymphoid system of the upper respiratory tract is an important part of the Waldeyer ring.Inflammation in the nasopharynx and adjacent areas may cause repeated the stimulation of the inflammatory response due to pathological adenoid hyperplasia.It is nown that Th1/Th1 balance has an important role in the pathogenesis of adenoid hypertrophy,but the related research on Treg,and Th17 is very little.Therefore,we have designed a research study of preschool-aged children(3-6 years)to measure the number of Th17 and Treg cells as well as the expression of related genes and cytokines in both peripheral blood and adenoid tissue.Our aims are to investigate the significance of the Th17 / Treg ratio in children with OSA,including the effect of changes in this ratio on the local and systemic inflammatory response.OSAHS Children often also suffer from allergic rhinitis and/or secretory otitis media.It is known that the deviation of Treg/Th17 is related to AR,So this study research on the abnormal of Treg in children with adenoid hypertrophy,and complicated with AR and/or OME.MethodsThe study was designed to case-control candidate genes association analysis1.SubjectsChildren(ages 3 to 6 years)with OSA newly confirmed by overnight PSG were initially recruited into the OSA group.Children diagnosed with chronic tonsillitis who underwent surgical treatment and were excluded from a diagnosis of OSA by PSG were recruited as the control group.All patients were determined to be free of other cardiovascular,endocrine,urinary system,metabolic and neuromuscular diseases and disorders.The selected patients had no specific response to aspirin,bronchiectasis,typical histories of autoimmune diseases,or severe respiratory infection within two weeks prior to enrollment.History of allergic rhinitis,asthma or other allergic diseases were recorded for all children.Skin prick tests were performed to assess allergens,and fiber nasopharyngoscopy was performed to assess adenoid size.Routine preoperative examinations were performed to exclude surgical contraindications.The fiber nasopharyngoscopy was operated by the fixed endoscopist in Endoscopy room.Based on the results of the fiber nasopharyngoscopy,adenoid size was classified into four groups of differing degrees: level ?(0-25% nostril blockage),level ?(26%-50% blockage),level ?(51%-75% blockage),and level ?(76%-100% blockage)[2].level and level ? were mild hypertrophy,which normally do not cause obstruction of the airway.level ? was called moderate hypertrophy,and level ? was called severe hypertrophy.According to the "children with obstructive sleep apnea syndrome treatment guidelines" published in 2007 by the Chinese Journal of Otorhinolaryngology Head and Neck,a diagnosis of OSA is established when the obstructive apnea index(AOI)is greater than 1 / hour or the obstructive apnea hypopnea index(AHI)is greater than 5 times / hour and the lowest oxygen saturation is less than 92%.2.The object of study groupChildren with adenoid level and level ? hypertrophy had an AHI lower than 5,no complaints of sleep apnea and no allergic rhinitis,which is called group I(adenoid level and level ? group,n=22)for short.The OSA children were divided into groups:group ? was the adenoid ? group(moderate hypertrophy group,n=3),group ? was the adenoid ? group(severe hypertrophy group,n=20),group ? was the OSA + AR group(OSHAS children with concurrent allergic rhinitis,n=32).group ? was the OSA + OME group(OSHAS children with OME,n=37).group ? was the OSA + AR+OME group(OSHAS children with AR and OME,n=31).The study was approved by the Institutional Review Board of Shanghai Children's Hospital.The parents of all the children provided informed consent to take the children's blood and adenoid tissue for research.3.research methodWe measured the number of Th17 and Treg cells,the levels of related serum cytokine IL-17?IL-10?TGF-?in cellular secretions,and the expression of key transcription factors ROR?t ?Foxp3 in both peripheral blood and adenoid tissue.IV Analysis method Values in all tables and figures are expressed as the mean ±standard deviation(SD).Statistically significant differences between the values were determined using Student's t-test.Grouped data were analyzed using a one-way analysis of variance(ANOVA).Statistical analyses were performed using a commercial software package((SPSS,version 16.0 for Windows;SPSS Inc.,Chicago,IL).A P-value less than 0.05 indicates significance.Results 1.Compared with the control group,OSA children exhibited a significant increasein peripheral Th17 cell number,Th17-related cytokine secretion(IL-17),andROR?t mRNA levels,whereas they exhibited a decrease in Treg cell number,Treg-related cytokine secretions(IL-10,TGF-?)and Foxp3 mRNA levels.TheTh17 / Treg ratio was higher(p <0.05)in the OSA groups than in the controlgroup.The Th17 / Treg ratio was correlated with the size of the adenoids.2.The Th17 / Treg balance in OSA patients was complicated by allergic rhinitis;theincrease was significantly larger in the AR group(p<0.05,p=0.021)than in OSAgroups without AR.3.The ratio of Th17/Treg in adenoid hypertrophy with secretory otitis media inchildren with peripheral blood and adenoid local were increased,which is smallerthan the deviation of Th17/Treg in adenoids hypertrophy in children.4.the ratio of Th17/Treg to offset in adenoid hypertrophy complicated with allergicrhinitis and secretory otitis media group has no obvious difference than theadenoids hypertrophy group,but higher than the offset ratio of adenoidhypertrophy with otitis media.ConclusionTh17 / Treg imbalance may increase the risk of developing OSA,and it isrelated with the size of adenoid.The ratio of deviation complicated with allergicrhinitis is more obvious,with secretory otitis media when the ratio of offsetreduced.ratio of Th17/Treg in adenoid hypertrophy complicated with allergicrhinitis and secretory otitis media increased,and is more obvious than the shift inadenoid hypertrophy with secretory otitis media.