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【medical-news】扁桃体完好无损的儿童复发链球菌感染的风险是切除儿童的3倍（sina采用）

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Intact tonsils triple risk of recurrent strep throat
ROCHESTER, Minn. -- Children with recurrent strep throat whose tonsils have not been removed are over three times more likely to develop subsequent episodes of strep throat than children who undergo tonsillectomy, according to a Mayo Clinic study published in the Nov. 2 issue of Laryngoscope.

"These results suggest that tonsillectomy is a useful therapy for treating children with recurrent strep throat infections," says Laura Orvidas, M.D., Mayo Clinic ear, nose and throat surgeon and senior study investigator. "It should decrease the amount of infections experienced by this subset of children and therefore diminish the number of missed school days and hopefully improve overall quality of life."

Dr. Orvidas and colleagues conducted a population-based retrospective cohort study of children between ages 4 and 16 who received three or more diagnoses of strep-related tonsillitis or pharyngitis at least one month apart, within 12 months. Within this group, children who subsequently underwent a tonsillectomy were compared with an age- and sex-matched sample of children who had not had a tonsillectomy. The date of the tonsillectomy for the matched pair was defined as the index date. All strep infections were recorded for both groups of children.

The study population comprised 290 children (145 who received a tonsillectomy and 145 who did not). In the tonsillectomy group, 74 children experienced at least one strep infection after the index date and before age 16. Among those who did not receive a tonsillectomy, 122 experienced at least one strep infection during the follow-up. The time before first subsequent strep infection was much longer for those who had a tonsillectomy, a median of 1.1 years as compared to 0.6 years for children whose tonsils had not been removed. By one year after the index date, the cumulative incidence of a strep infection was 23.1 percent among the children who had a tonsillectomy compared to 58.5 percent among the children who had not.

Researchers used the Rochester Epidemiology Project to identify children for the study, which was limited to children who resided in Olmsted County, Minn., between Jan. 1, 1994, and Dec. 31, 1998. The Rochester Epidemiology Project has developed an index for the records of virtually all providers of medical care in Olmsted County. Olmsted County is served by a largely unified medical care system, including Mayo Clinic, that has accumulated comprehensive clinical records since the early 1900s.

"The use of the Rochester Epidemiology Project resource was unquestionably one of the strengths of the study," says Dr. Orvidas. "This resource allowed us to access complete medical records on a geographically defined pediatric population and minimized potential referral and participation biases."

The next step of the research phase, according to Dr. Orvidas, would be a prospective randomized trial investigating the use of tonsillectomy for recurrent strep throat infections. Such an investigation could judge outcomes based on the number of subsequent infections and on quality of life issues, she says.

Pharyngitis and tonsillitis are among the most commonly diagnosed pediatric illnesses, accounting for approximately 18 million physician office visits per year. Strep infections are responsible for 15 percent to 30 percent of all cases of pharyngitis. In addition, 20 percent to 30 percent of children who are diagnosed with strep pharyngeal infection may experience a second infection within 60 days of the initial episode.

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2006-11-03 01:18 浏览 : 1136 回复 : 4

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riset 编辑于 2006-11-08 16:58

• 医生休假，能做到完全不受临床的干扰吗？

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本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。

2006-11-03 10:36

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• 八十年前协和医院大查房漫画曝光，折射出当代医疗界乱像

yong005

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若wzhjuan 战友未能完成，我认领了

2006-11-05 20:57

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yong005 编辑于 2006-11-07 15:40

• 王雪强教授康复团队招聘博士后应聘

yong005

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翻译完成，请指正，谢谢！

扁桃体完好无损的儿童复发链球菌感染的风险是摘除儿童的3倍

根据11月2日发行的喉镜杂志，明尼苏达州罗彻斯特市Mayo诊所的研究表明：扁桃体没有摘除的儿童复发链球菌感染是摘除儿童的3倍，并且容易产生一系列咽喉部的合并症。

“这些研究表明，扁桃体摘除术是治疗儿童咽部复发链球菌感染的一种有效方法”。医学博士，Mayo诊所耳鼻咽喉外科医生及高级研究员Laura Orvidas说，“那应该会减少儿童的感染机会，因此将减少孩子们耽误学习的时间和改善他们的整体生活质量”。

Orvidas博士和同事进行了一项以人口为基础的回顾性队列研究，对象为4－16岁的儿童。这些儿童在12个月以内，至少有一个月被3次或3次以上诊断为链球菌相关的扁桃体炎或咽炎。其中，接下来做了扁桃体摘除术的儿童按年龄和性别与没有做扁桃体摘除的儿童对照。做扁桃体摘除术的日期被规定为各组的开始日期。各组儿童的链球菌感染均被记录。

这项研究包括290名儿童（145例做了扁桃体摘除，另145例没做扁桃体摘除）。在扁桃体摘除组，74例儿童在开始日期到16岁之前至少有一次链球菌感染。在没有做扁桃体摘除的儿童中，122例在整个随访期至少有一次链球菌感染。做过扁桃体摘除的儿童出现第一次链球菌感染的时间比没做的儿童更长，平均是1.1年比0.6年。从开始日期到1年，做过扁桃体摘除的儿童的链球菌感染率是23.1％，而没做的是58.5％。

研究者使用罗彻斯特流行病学项目来为研究选定对象。这些儿童全部为在1994年1月1日至1998年12月31日间居住在明尼苏达州欧姆斯德县的。罗彻斯特流行病学项目的开发建设几乎涵盖了欧姆斯德县所有有记录的医疗机构。欧姆斯德县拥有一个庞大统一的医疗服务系统，包括从二十世纪早期以来就已经累积了完整临床记录的Mayo诊所。

“罗彻斯特流行病学项目资源的作用是该项研究不容置疑的优势之一”。Orvidas博士说。“地理上限定儿童人口和最小化就诊和转诊误差使得我们得到了完整的医学记录”。

据Orvidas博士说，下一阶段的研究将随机任意追踪调查扁桃体摘除术对咽喉部复发链球菌感染的预期作用。调查结果的判定是基于复发感染的次数和生活质量。

咽炎、扁桃体炎是儿科最常见的疾病，每年大约有1800万人到内科就诊。链球菌感染占所有咽炎的15％至30％，此外，20％至30％被诊断为咽部链球菌感染的儿童在首次感染后的60天内可能经历第二次感染。

2006-11-07 15:38

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yong005 编辑于 2006-11-07 18:53

• 医生休假，能做到完全不受临床的干扰吗？

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