Association of Long-term Risk of Respiratory, Allergic, and Infectious Diseases With Removal of Adenoids and Tonsils in Childhood
Association of Long-term Risk of Respiratory, Allergic, and Infectious Diseases With Removal of Adenoids and Tonsils in Childhood
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DOI：
10.1001/jamaoto.2018.0614
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发表时间：
2018-07-01
影响因子：
7.8
通讯作者：
Boomsma, Jacobus J.
中科院分区：
文献类型：
--
作者：
Byars, Sean G.;Stearns, Stephen C.;Boomsma, Jacobus J.
手术切除腺样体和扁桃体以治疗呼吸困难或复发性中耳炎仍然是常见的儿科手术;然而，尽管事实上这些淋巴器官在免疫系统的发育和功能中起着重要作用，但对它们的长期健康后果知之甚少。目的评估儿童期腺样体切除术、扁桃体切除术和腺样体扁桃体切除术相关的长期疾病风险。设计，背景和参与者：对1979年至1999年在丹麦出生的多达1189061名儿童进行了一项基于人群的队列研究，并在2009年之前的相关国家登记册中进行了评估，涵盖了他们生命的前10年和30年。选择病例组和对照组的参与者，使他们的健康在手术前没有显著差异。暴露如果参与者在生命的前9年内被切除腺样体或扁桃体，则被归类为暴露。（由国际疾病分类定义，第八版[ICD-8]和第十版[ICD-10]诊断）采用分层考克斯比例风险回归分析对30岁以下的儿童进行了检查，该回归分析调整了18个协变量，包括父母疾病史、妊娠并发症、出生体重、Apgar评分、性别，结果：共有1189061名儿童被纳入本研究（48%为女性）; 17460名儿童接受腺样体切除术。扁桃体切除术11 830例，扁桃体腺样体切除术31 377例，对照组1157 684例。腺样体切除术和扁桃体切除术与上呼吸道疾病的2- 3倍增加相关（相对风险[RR]，1.99; 95%CI，1.51-2.63和RR，2.72; 95%CI，1.54-4.80;分别）。还发现感染性和过敏性疾病的风险增加较小：腺样体扁桃体切除术与感染性疾病风险增加17%相关（RR，1.17; 95% CI，1.10-1.25），对应于绝对风险增加2.14%，因为这些疾病在人群中相对常见（12%）。相比之下，这些手术旨在治疗的疾病的长期风险往往没有显着差异，有时更低或更高。结论和相关性在这项研究中，近120万儿童，其中17 460腺样体切除术。11830例扁桃体切除术和31377例腺样体切除术与呼吸道、感染性和过敏性疾病的长期风险增加相关。虽然在有这些数据的情况下，使用了严格的混杂控制，但这些影响可能无法完全解释，我们的研究结果表明，在决定进行扁桃体切除术或腺样体切除术时，考虑长期风险是很重要的。
IMPORTANCE Surgical removal of adenoids and tonsils to treat obstructed breathing or recurrent middle-ear infections remain common pediatric procedures; however, little is known about their long-term health consequences despite the fact that these lymphatic organs play important roles in the development and function of the immune system.OBJECTIVE To estimate long-term disease risks associated with adenoidectomy, tonsillectomy, and adenotonsillectomy in childhood.DESIGN, SETTING, AND PARTICIPANTS A population-based cohort study of up to 1189 061 children born in Denmark between 1979 and 1999 and evaluated in linked national registers up to 2009, covering at least the first 10 and up to 30 years of their life, was carried out. Participants in the case and control groups were selected such that their health did not differ significantly prior to surgery.EXPOSURES Participants were classified as exposed if adenoids or tonsils were removed within the first 9 years of life.MAIN OUTCOMES AND MEASURES The incidence of disease (defined by International Classification of Diseases, Eighth Revision [ICD-8] and Tenth Revision [ICD-10] diagnoses) up to age 30 years was examined using stratified Cox proportional hazard regressions that adjusted for 18 covariates, including parental disease history, pregnancy complications, birth weight, Apgar score, sex, socioeconomic markers, and region of Denmark born.RESULTS A total of up to 1 189 061 children were included in this study (48% female); 17 460 underwent adenoidectomy. 11 830 tonsillectomy, and 31 377 adenotonsillectomy; 1157 684 were in the control group. Adenoidectomy and tonsillectomy were associated with a 2- to 3-fold increase in diseases of the upper respiratory tract (relative risk [RR], 1.99; 95% CI, 1.51-2.63 and RR, 2.72; 95% CI, 1.54-4.80; respectively). Smaller increases in risks for infectious and allergic diseases were also found: adenotonsillectomy was associated with a 17% increased risk of infectious diseases (RR, 1.17; 95% CI, 1.10-1.25) corresponding to an absolute risk increase of 2.14% because these diseases are relatively common (12%) in the population. In contrast, the long-term risks for conditions that these surgeries aim to treat often did not differ significantly and were sometimes lower or higher.CONCLUSIONS AND RELEVANCE In this study of almost 1.2 million children, of whom 17 460 had adenoidectomy. 11830 tonsillectomy, and 31 377 adenotonsillectomy, surgeries were associated with increased long-term risks of respiratory, infectious, and allergic diseases. Although rigorous controls for confounding were used where such data were available, it is possible these effects could not be fully accounted for, Our results suggest it is important to consider long-term risks when making decisions to perform tonsillectomy or adenoidectomy.