| Objective:To systematic review the changes of immune function after tonsillectomy and(or)adenoidectomy in children,so that to provide evidence-based medicine for a better clinical decision about tonsillectomy and adenoidectomy.Method:Literatures about the changes of immune function after tonsillectomy and(or)adenoidectomy in children were searched in Pubmed,The Cochrane Library,Web of science and CNKI,WanFang Data and VIP inception to June 2018,and 2 reviewers independently screened literatures according to the inclusion and exclusion criteria,extracted data,and assessed the risk of bias of included studies.Then meta-analysis was performed using RevMan 5.3 software.Result:A total of 15 literatures involving 846 patients were included in the meta-analysis.First,the results of meta-analysis showed that:? The meta-analysis of humoral immune index in 1 month after operation:(1)There were no significant difference in serum IgG between the operated group and control group 1month after operation [MD=-0.53,95%CI(-1.18~0.12)(P=0.11)].(2)The level of serum IgA in operated group were lower compared to the control group 1month after operation,the difference was statistically significant [MD=-0.23,95%CI(-0.42~-0.04)(P<0.05)].(3)There were no significant difference in serum IgM between the operated group and control group 1month after operation [MD=-0.03,95%CI(-0.08~0.02)(P>0.05)].? The meta-analysis of cellular immune index in 1 month after operation:(1)There were no significant difference in serum CD3+ between the operated group and control group 1month after operation[MD=-0.60,95%CI(-2.51,1.31)(P=0.54)].(2)There were no significant difference in serum CD4+ between the operated group and control group 1month after operation[MD=-2.34,95%CI(-4.95,0.28)(P=0.08)].(3)The level of serum CD8+ in operated group were significantly difference from the control group 1month after operation[MD=2.46,95%CI(0.82~4.10)(P<0.05)].(4)The level of serum CD4+/CD8+ in operated group were significantly difference from the control group 1month after operation[MD=-0.35,95%CI(-0.61~-0.08)(P=0.01)].? The meta-analysis of humoral immune index in the forward post-surgery:(1)There were no significant difference in serum IgG between the operated group and control group in the forward post-surgery[MD=-0.06,95%CI ?(-0.24 ~ 0.11)(P=0.46)].(2)There were no significant difference in serum IgA between the operated group and control group in the forward post-surgery[MD=2.33,95%CI [-1.46~6.13](P=0.23)].(3)There were no significant difference in serum IgM between the operated group and control group in the forward post-surgery.[MD=-0.02,95%CI(-0.08~0.04)(P=0.47)].?The meta-analysis of cellular immune index in the forward post-surgery:(1)There were no significant difference in serum CD3+ between the operated group and control group in the forward post-surgery[MD=-0.65,95%CI(-1.41~0.10)(P=0.09)].(2)There were no significant difference in serum CD4+ between the operated group and control group in the forward post-surgery[MD=0.16,95%CI(-1.61~1.93)(P=0.86)].(3)The level of serum CD8+ in operated group were significantly difference from the control group in the forward post-surgery [MD=-0.56,95%CI(-1.51~0.04)(P=0.07)].(4)The level of serum CD4+/CD8+ in operated group were significantly difference from the control group in the forward post-surgery[MD=-0.03,95%CI(-0.10,0.05)(P=0.46)].Second,there are 2 literatures involving the differences between the tonsillotomy and tonsillectomy which have effect on children immune system.The conclusion showed that there were no significantly difference between the two surgical procedures.Conclusion:(1)The Cyto immunity and humoral immunity were significantly changed in the short-term post-surgery(1 month),and revored in the long-term post-surgery(more than 3 months).(2)There were no significant difference in the effect on children immune system between the tonsillotomy and tonsillectomy. |
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