| Objective: To explore the effect of tonsil adenoidectomy to allergic rhinitis' s outcomes in children with obstructive sleep apnea hypopnea syndrome complicated with allergic rhinitis.And analysis the probable mechanism based on the Th17/Treg imbalancce theory.Methods: We collected 53 patients who were diagnosed as obstructive sleep apnea hypopnea syndrome and prepared to have tonsil adenoidectomy in the department of Otolaryngology-Head & Neck Surgery,Shanghai Children's Hospital,from June to October in 2016.They were divided into two groups: obstructive sleep apnea hypopnea syndrome complicated with allergic rhinitis group(group I)had 26 patients,obstructive sleep apnea hypopnea syndrome without allergic rhinitis group(group II)had 27 patients.All of the patients were detected the contents of peripheral blood Th17,Treg cells with flow cytometry(FCM),and the expression of the representative cytokines IL–17A,TGF-beta with enzyme-linked immunosorbent assay(ELISA)before the surgery.Then they were treated with tonsil adenoidectomy.And detected the contents of peripheral blood Th17,Treg cells and the expression of cytokines TGF-beta,IL–17A with the same methods after the surgery 3 months later when follow-up.At the same time,patients in group I had a AR's symptoms and signs score before and after the surgery,to evaluate the efficacy of surgical treatment to allergic rhinitis.Results:1.There had an obviously decrease after the suegery in the total symptoms score,the total signs score,the number of daily blow their noses,nasal congestionand nasal itching in the obstructive sleep apnea hypopnea syndrome complicated with allergic rhinitis group(group I),and the difference was significant(P<0.05).According to the allergic rhinitis' s symptoms and signs scoring criteria and effect evaluation method,14 patients were markedly improved(63.6%),6 patients were effective improved(27.3%),2 patients were valid(9.1%),the total effective rate was 90.9%.2.When compared to group II before the surgery,the percentage of Treg cells in group I decreased,the percentage of Th17 cells and Th17 / Treg ratio increased,and the difference was significant(P<0.05).After the surgery,the percentage of Treg cells in group I also had an obvious decrease(P<0.05),and the percentage of Th17 cells and the Th17/Treg ratio between the two groups had no significant difference(P>0.05).When compared to the condition before the surgery,the percentage of Treg cells increased and the Th17/Treg ratio decreased in both of the two groups,and the percentage of Th17 cells decreased in group I,and the difference was significant(P<0.05).3.When compared to group II before the surgery,the level of TGF-? in group I decreased and the level of IL-17 A increased,and the difference was significant(P<0.05).After the surgery,the levels of TGF-? and IL-17 A between the two groups had no significant difference(P>0.05).When compared the condition before the surgery,the level of IL-17 A decreased in both of the two groups,and the difference was significant(P<0.05).4.The correlation analysis between the efficacy of the surgery treatment to AR patients and the percentage of Treg cells,Th17 cells and Th17/Treg ratio,the level of TGF-? and IL-17 A in group I.We found that the correlation between the efficacy and the Th17/Treg ratio was significant(r = 0.564,p = 0.564),the correlation between the efficacy and the percentage of Treg cells,Th17 cells and the level of TGF-? and IL-17 A has no significance.Conclution: Tonsilloadenoiectomy can not only treat obstructive sleep apnea hypopnea syndrome,but also has significant effect to allergic rhinitis in children with obstructive sleep apnea hypopnea syndrome complicated with allergic rhinitis.Th17/Treg imbalance mechanism may play an important role.It can provide a theoretical foundation for clinical doctors for the treatment and the prognosis of the patients,and may provide an answer to the parents' questions. |
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