X线定位侧位片测量鼾症儿童上气道结构

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摘要目的：利用X线定位侧位片测量原发性鼾症（PS）及阻塞性睡眠呼吸暂停低通气综合征（OSAHS）儿童上气道及其周围结构，探讨鼾症儿童上气道的结构特点。方法：选择2008年10月至2010年12月因打鼾来本院就诊的儿童，根据多导睡眠监测结果分为PS组53例，轻度OSAHS组51例，中重度OSAHS组57例；选择同期抽动-秽语综合征、无打鼾儿童50例作为对照组。对四组儿童颅面骨性结构、软组织、上气道及其空间结构进行测量。结果：骨性结构测量：鼾症各组儿童舌骨-下颌平面距（AH-MP）、舌骨-眼耳平面距（AH-FH）、舌骨-颈椎前平面距（AH-CVP）明显大于对照组（P＜0.05），鼾症各组间比较差异无统计学意义。软组织测量：鼾症儿童腺样体面积（AA）明显大于对照组（P＜0.05），中重度OSAHS组最大，轻度OSAHS组和PS组比较差异无统计学意义；鼾症儿童腺样体厚（AT）、软腭长（SPL）、软腭厚（SPT）、软腭面积（SPA）明显大于对照组（P＜0.05），鼾症各组间比较差异无统计学意义。上气道测量：鼾症儿童鼻咽气道面积（NA）、鼻咽气道前后径（PNS-UPW）、最窄后气道间隙（PAS）明显小于对照组（P＜0.05），中重度OSAHS组最小，轻度OSAHS组和PS组比较差异无统计学意义；鼾症儿童腭咽气道面积（PA）、腭咽气道前后径（SPP-SPPW）明显小于对照组（P＜0.05），鼾症各组间比较差异无统计学意义。空间结构测量：鼾症儿童腺样体鼻咽腔比率（A/N）、腺样体/鼻咽腔面积（AA/NTA）明显大于对照组（P＜0.05），中重度OSAHS组最大，轻度OSAHS组和PS组比较差异无统计学意义。鼾症儿童最窄后气道间隙/气管直径（PAS/TD）明显小于对照组（P＜0.05），中重度OSAHS组最小，轻度OSAHS组和PS组比较差异无统计学意义。AT、AA、SPA、A/N、AA/NTA与呼吸紊乱指数（AHI）呈正相关（P＜0.05），NA、PNS-UPW、PA、SPP-SPPW、PAS、PAS/TD与AHI呈负相关（P＜0.05）。结论：腺样体肥大阻塞鼻咽部气道，扁桃体肥大、软腭增大加重了腭咽部气道阻塞；低位、靠前的舌骨是造成鼾症的原因之一；X线能较好地测量上气道及其周围结构，在鼾症儿童上气道结构研究中具有重要价值。

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	宣妙燕1
	王红霞1
	李婷1
	潘丽萍1
	白光辉2
	蔡晓红1

Abstract：Objective: To investigate upper airway structure of snoring children through measuring upper airway and surrounding structures of the primary snoring (PS) and obstructive sleep apnea-hypopnea syndrome (OSAHS) children on the lateral X ray film. Methods: The children who came to this hospital because of snoring from October 2008 to December 2010 were be selected. According to the results of polysommography, the children were divided into PS group (53 cases), mild OSAHS group (51 cases), moderate and severe OSAHS group (57 cases). 50 cases unsnoring children were be selected as control group. The four groups were examined with lateral X ray film, and the craniofacial hard tissues, soft tissues, upper airway and space structure were measured. Results: Bone sex structures measured: the hyoid-mandible plane distance (AH-MP), hyoid-frankfort horizontal plane distance (AH-FH), hyoid-precervical vertebra plane distance (AH-CVP)of the three snoring groups obviously increased as compared with the normal group (P<0.05). There was no statistical differences among three snoring groups. Soft tissues measured: the adenoid area (AA) of snoring groups obviously increased as compared with the normal group (P<0.05). The moderate and severe OSAHS group was the maximum, and there was nostatistical differences between PS group and mild OSAHS group. The adenoid thickness (AT), soft palate length (SPL), soft palate thickness (SPT), and soft palate area (SPA) of snoring groups obviously increased as compared with the normal group (P<0.05). There was no statistical differences among snoring groups. Upper airway measured: the posterior airway interstitial (PAS), nasopharyngeal airway area (NA), and nasopharyngeal airway anteroposterior diameter (PNS- UPW) of snoring groups obviously decreased as compared with the normal group (P<0.05). The moderate and severe OSAHS group were the least, and there was no statistical differences between PS group and mild OSAHS group. The palatopharyngeal airway area (PA) and posterior soft palate- posterior soft palate pharynxwall distance (namely palatopharyngeal airway anteroposterior diameter, SPP-SPPW) of snoring groups obviously decreased as compared with the normal group (P<0.05). There was no statistical differences among snoring groups. Space structures measured: the adenoidal - nasopharyngeal ratio (A/N) and adenoidal area-nasopharyngeal area ratio (AA/NTA) of snoring groups obviously increased as compared with the normal group (P<0.05). The moderate and severe OSAHS group was the maximum, and there was no statistical differences between PS group and mild OSAHS group. The PAS-trachea diameter ratio (PAS/TD)of snoring groups obviously decreased as compared with the normal group (P<0.05). The moderate and severe OSAHS group were the least, and there was no statistical differences between PS group and mild OSAHS group. The result of the correlation analysis showed that the correlations between AT, AA, SPA, A/N, AA/NTA and AHI were all positive and significant (P<0.05). The correlations between NA, PNS-UPW, PA, SPP-SPPW, PAS, PAS/TD and AHI were all negative and significant (P<0.05). Conclusion: Adenoidal hypertrophy obstruct the nasopharyngeal airway, the hypertrophy of tonsils and soft palate make the palatopharyngeal and glossopharyngeal airway more serious. Low order and forward hyoid is one of the reasons lead to OSAHS. Lateral X ray film is used to understand upper airway and surrounding structure, and it has important value in research of upper airway structure in snoring children.

收稿日期: 2013-07-15

基金资助:

浙江省科技厅科研基金资助项目（2008C33011）；温州市科技局科研基金资助项目（Y2003A065）

通讯作者: 蔡晓红，主任医师，博士，Email：caixh839@sina.com

作者简介: 宣妙燕（1985-），女，浙江义乌人，住院医师，硕士。现工作单位：东阳市人民医院儿科

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2014/V44/I1/20

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