| BackgroundAdenoid is a group of lymph tissue located in the nasopharynx.There is a physiological enlargement of adenoid during the age of 2 to 6.The tissue will shrink gradually after 10 to 12 years old.If related symptoms exits because of the enlarged adenoid,the adenoid hypertrophy(AH)will be defined.Adenoid hypertrophy is the main cause of pediatric OS A in toddlers and pre-school children.As a result,slow growth and cognitive function disorder may happen.Adenoid face is another complication of the abnormal facial structure.Nasal endoscopy and PSG is the standard examination method for AH related OSA.During the testing process,there are some obstacles such as high cost on the equipment and human resource,or a long waiting time.Children could refuse to cope with the examiners.In recent years,some advantages were revealed of Traditional Chinese Medicine treatment in AH.The current method to evaluate the disease can not be widely used or be performed timely and dynamical.As a result,in order to screen the disease in the population of specific age,a simple and reliable screening tool is in need.Objective1.Based on clinic and character of AH related OSA,to develop a questionnaire which can be used in 2-12 susceptible children and to test the reliability and specificity of the questionnaire.2.To evaluate the screening accurency on adenoid hypertrophy and related OSA.To compare the questionnaire data with other clinic examination results before and after the Chinese Medicine invention.As to build a simple method on screening and efficiency evaluation.3.To explore the specification of TCM symptoms of adenoid hypertrophy by cluster analysis,which can be used as supportive evidence in TCM clinic.Furthermore,to analysis the correlation between questionnaire scores and TCM differentiations.Methods1.to develop the screening questionnaire for adenoid hypertrophy and related OSA:at first a team was organized.And then built an items pool by literature research and specialty consultants.An original format questionnaire was decided.Two pilot trials were performed to test the content understanding degree.The testing was completed in 213 cases.Item selection was based on item analysis,critical ratio,community test,factor analysis.Weighted factors score according to the logistic regression.A ROC curve was made with the total score and standard diagnose result.Cutoff line was decided by the Youden Index.By validation in 74 cases,reliability and validity,sensitivity and specificity were retested.The final questionnaire was established.2.Testing and evaluation on the questionnaire in Chinese Medicine clinic.Childeren with a chief complain of nasal obstruction or snoring received Chinese herbal intervention.Questionnaire information were collated,as well as adenoid image or nasal endoscopy.Compared with baseline,difference analysis were performed in questionnaire scores,endoscopy evaluation and AHI after the TCM treatment.Further more,the correlation analysis was performed between questionnaire scores and nasal endoscopy indicator,questionnaire scores and AHI.3.Cluster analysis in TCM syndrome differentiation in adenoid hypertrophy and related questionnaire score features exploration.A survey on TCM syndrome features were performed in adenoid hypertrophy children.The contents were based on literature research,diagnostics of traditional Chinese medicine and TCM expert consensus on adenoid hypertrophy and related sleep breath disorders.The survey included night symptoms,daytime symptoms,local symptoms and tongue diagnosis.Items were excluded if with an extreme high or low exiting percentage.Variables were devided with 2-5 clusters by R hierarchical clustering.Cluster number selected was decided by TCM experts.And then the main features were extracted by principle factor analysis and the characteristics of disease nature were received.Q hierarchical cluster analysis was performed on cases with 2 to 4 clusters.The final cluster number was decided by TCM experts according to the clinical differentiation experiences.To analysis the questionnaire score features in the cluster groups.Furthermore,explored the features in questionnaire scores based on types of TCM syndrome differentiation by t-test and correlation analysis.Results1.the screening questionnaire for adenoid hypertrophy and related OSA consists 12 items in four factors.Factor one is about sleep breathing,including items of sleep snoring,loud snoring,positional snoring and stop breath during sleep.Factor two is about daytime function,including items of inattention,irritation,hyperactive.Factor three is about nasal symptoms,including items of nasal obstruction,sneezing and yellowish snot.Factor four is about ear symptoms,including items of ear fullness,middle ear infection in last three months.The total score is calculated by:8 times factor one score + factor two score +factor three score+5 times factor four score.The cutoff line for screening adenoid hypertrophy is 35 with sensitivity of 88.2%and specificity of 64.5%.The cutoff line for OSA screening is 69,with sensitivity of 71.4%and specificity of 62.9%.2.31 cases were enrolled at the baseline.The questionnaire screening accuracy were evaluated at baseline.The average score of children without adenoid hypertrophy was 35.5,while the average score of adenoid hypertrophy was 77.41.The score was significant higher in adenoid hypertrophy group.There was a positive medium correlation between questionnaire score and adenoid hypertrophy diagnosis results(r=0.431,P<0.05).Using 35 as the cutoff value,the sensitivity for adenoid hypertrophy of questionnaire was 89.3%,and specificity of 66.7%.The average score of children adenoid hypertrophy and related OSA was 89.3,while the average score of adenoid hypertrophy without OSA was 37.64..The score was significant higher in adenoid hypertrophy and related OSA group.here was a positive medium correlation between questionnaire score and AHI(r=0.499,P<0.05).Using 69 as the cutoff value,the sensitivity for OSA of questionnaire was 75%,and specificity of 54.5%.The therapeutic efficiency was evaluated in 21 cases with endescopy examination results.After the treatment,the adenoid size droped from 71.33%to 64.19%of choana.The questionnaire score decreased from 71.9 to 47.9.There were significant differences in adenoid size and questionnaire score after the intervention(P<0.01).The total score of questionnaire showed significant medium correlation with adenoid size.The therapeutic efficiency was evaluated in 16 cases with PSG results.After the treatment,the AHI decreased from 14.23 to 5.88.The questionnaire score decreased from74.08 to 45.92.There were significant differences in AHI and questionnaire score after the intervention(P<0.01).The total score of questionnaire showed significant medium correlation with AHI.3.137 children with adenoid hypertrophy and 37 children without adenoid hypertrophy were enrolled in the survey.The frequency of each items were calculated.The items of extreme frequency(less than 5%and more than 90%)were re moved firstly.63 variables were used in the cluster analysis.The variable was clustered by R method with 2-5 groups.The results were evaluated by clinic specialty.When variables divided by 2 clusters,-the disease nature of deficiency and excess can be revealed.When variables divided by 4 clusters,the degree of abnormal fluid distribution was different in 4 groups.Cases were clustered by Q method.The results were evaluated by clinic specialty.When cases were divided into 2 groups,meeting the TCM differentiation of deficiency and excess(Qi deficiency pattern and phlegm-blood stasis pattern).When divided by 4 groups,there are some common features with the results of traditional differentiation method.The group features were summarized and name as Qi and Yin deficiency,Qi deficiency in the Lung and the Spleen,Lung heating and Jin deficiency,phlegm obstruction and blood stasis.Questionnaire score were analyzed between these groups.The average score in deficiency group was 49.72,while the average score in excess group was 72.43.The average sleep breath factors in deficiency group was 5.33,while 7.11 in excess group.The average nasal factors in deficiency group was 3.27,and 5.68 in excess group.The average ear factors in deficiency group was 0.25,while 0.91 in excess group.There were significant difference between groups of deficiency and excess groups.Analysis the score features with SNK method.The total score is lowest in Qi and Yin defiency group,medium in Qi deficiency of Lung and Spleen and highest in the other two groups.The average score in daytime function factors was lowest in Qi and Yin defiency group,compared with other three groups.The score of nasal symptoms in Qi and Yin defiency group,Qi deficiency of Lung and Spleen group were lower than that of the other two groups.The score of ear symptoms were highest in phlegm obstruction and blood stasis group.Conclusion1.There are 12 items in the screening questionnaire for adenoid hypertrophy and related OSA,involving four factors,including sleep breath,daytime function,nasal syptoms and ear problems.The reliability and validation were evaluated.Using 35 to screen adenoid hypertrophy and 69 to screen adenoid hypertrophy related OS A.Sensitivity and specificity were satisfied.The questionnaire can be used as a supplement tool to screen adenoid hypertrophy without the traditional method,and to evaluated the efficiency during TCM treatment.2.During the baseline screening process,the questionnaire scores had significant differences in adenoid group and non-adenoid group.A correlation was found between questionnaire scores and adenoid size or AHI.The sensitive and specificity were satisfied.After the TCM treatment,questionnaire score got lower compared with the score before TCM treatment.The same results also were found in AHI and adenoid size.A medium positive correlation was found in score and adenoid size or AHI.The questionnaire score can reflect the symptoms changes in TCM treatment.3.Based on the analysis on TCM symptoms,the disease nature of adenoid hypertrophy included deficiency and excess,with the different level of liquid distribution.Based on case cluster,there were 2 main groups in adenoid hypertrophy,including deficiency and excessive.With the group number of 4,Qi and Yin deficiency,Qi deficiency of Lung and Spleen,Lung heating Jin deficiency,phlegm obstruction and blood stasis were clustered.The questionnaire score showed significant difference between the deficiency and excess group.Compared with Qi and Yin deficiency,Qi deficiency in Lung and Spleen,the other two groups had a higher score in sleep breath factor and daytime function factor.Compared with Qi and Yin deficiency,Qi deficiency in Lung and Spleen had a higher score in daytime function score.The ear factor score was highest in phlegm obstruction and blood stasis group.The questionnaire may play a role in TCM symdromes analysis in adenoid hypertrophy in the future. |
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