Clinical characteristics and risk factors of recurrent acute infectious epiglottitis in adults
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摘要: 目的 探讨成人急性感染性会厌炎复发的临床特征和危险因素。方法 回顾性分析2012年1月—2019年12月在南通大学附属海安医院耳鼻咽喉科住院及门急诊治疗的成人急性感染性会厌炎患者的相关资料。结果 331例成人急性感染性会厌炎患者的复发率为4.2%(14/331)，其中10例复发1次，4例复发2次。所有患者起病时间均在48 h以内，复发组最常见的主诉为咽喉疼痛(42.9%)，非复发组为吞咽困难(42.0%)。复发组的饮酒频率高于非复发组(P=0.009)。复发组慢性阻塞性肺疾病(COPD)、糖尿病、会厌囊肿和胃食管反流疾病/咽喉反流疾病的发生率高于非复发组。除喉镜下舌扁桃体感染外，两组在其他临床特征、治疗和预后方面均无显著差异。多变量分析表明，经常饮酒(≥2次/周)、COPD、糖尿病、会厌囊肿和舌扁桃体感染是成人急性感染性会厌炎复发的危险因素。结论 成人急性感染性会厌炎有一定比例会单次或多次复发，经常饮酒、COPD、糖尿病、会厌囊肿和舌扁桃体感染是急性感染性会厌炎复发的危险因素。Abstract: Objective The purpose of this study was to investigate the clinical characteristics and risk factors of adult recurrent acute infectious epiglottitis.Methods All patients diagnosed with acute infectious epiglottitis hospitalized in the Department of Otolaryngology, Hai'an People's Hospital, Nantong University from January 2012 to December 2019 were included.Results The recurrence rate of 331 adult patients with acute infectious epiglottitis was 4.2% (14/331), including 10 cases of once recurrence and 4 cases of twice recurrence. The onset time of all patients was within 48 hours. The most common main complaint in the recurrent group was sore throat (42.9%), and dysphagia in the non-recurrent group (42.0%). The frequency of drinking in recurrent group was higher than that in non-recurrent group (P=0.009). The incidence of chronic obstructive pulmoriary disease(COPD), diabetes, cyst and gastroesophageal reflux disease/laryngopharyngeal reflux disease in recurrent group was higher than that in non-recurrent group. There was no significant difference in other clinical features, treatment and prognosis between the two groups except tongue tonsil infection under laryngoscope. Multivariate analysis showed that frequent drinking (more than twice a week), COPD, diabetes, cysts and lingual tonsillar infection were the risk factors for recurrence.Conclusion Adult acute infectious epiglottitis has a proportion of single or multiple recurrence. Frequent drinking, COPD, diabetes, cyst and lingual tonsillar infection are the risk factors for the recurrence.
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Key words:
- acute epiglottitis /
- recurrence /
- clinical features /
- risk factors
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表 1 成人复发性急性会厌炎患者的一般临床资料分析
例(%) 项目 总例数(n=331) 复发组(n=14) 无复发组(n=317) P值 年龄/岁 0.182 ＜45 122(36.9) 2(14.3) 120(37.9) 45~65 150(45.3) 9(64.3) 141(44.5) ＞65 59(17.8) 3(21.4) 56(17.7) 性别 0.786 男 201(60.7) 8(57.1) 193(60.9) 女 130(39.3) 6(42.9) 124(39.1) 饮酒 0.009 从不 210(63.4) 5(35.7) 205(64.7) 偶尔(＜2次/周) 62(18.7) 2(14.3) 60(18.9) 经常(≥2次/周) 59(17.8) 7(50.0) 52(16.4) 吸烟 0.476 从不 192(58.0) 7(50.0) 185(58.4) 戒烟(＞3个月) 11(3.3) 1(7.1) 10(3.2) 仍在吸烟 128(38.7) 6(42.9) 122(38.5) 伴发疾病 慢性鼻窦炎 65(19.6) 4(28.6) 61(19.2) 0.488 COPD 33(10.0) 4(28.6) 29(9.1) 0.040 糖尿病 57(17.2) 7(50.0) 50(15.8) 0.004 高血压 81(24.5) 4(28.6) 77(24.3) 0.752 恶性肿瘤 17(5.1) 0(0) 17(5.4) 1.000 慢性肝炎 36(10.9) 2(14.3) 34(10.7) 0.656 会厌囊肿 43(13.0) 8(57.1) 35(11.0) ＜0.001 GERD/LPRD 55(16.6) 6(42.9) 49(15.5) 0.017 
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表 2 成人复发性急性会厌炎患者的临床特征分析
例(%) 项目 总例数(n=331) 复发组(n=14) 无复发组(n=317) P值 发病时间/h 0.594 ＜12 138(41.7) 4(28.6) 134(42.3) 12~48 133(40.2) 7(50.0) 126(39.7) ＞48 60(18.1) 3(21.4) 57(18.0) 主要症状 0.489 咽喉疼痛 130(39.3) 6(42.9) 124(39.1) 吞咽困难 137(41.4) 4(28.6) 133(42.0) 呼吸困难 50(15.1) 3(21.4) 47(14.8) 发声含糊 14(4.2) 1(7.1) 13(4.1) 病因(诱因) 0.636 感染 217(65.6) 8(57.1) 209(65.9) 邻近组织感染 50(15.1) 2(14.3) 48(15.1) 异物损伤 16(4.8) 1(7.1) 15(4.7) 热损伤 15(4.5) 1(7.1) 14(4.4) 化学损伤 33(10.0) 2(14.3) 31(9.8) 白细胞计数 2.226 ＜4000 7(2.1) 1(7.1) 6(1.9) 4000~10000 29(8.8) 1(7.1) 28(8.8) ＞10000 295(89.1) 12(85.7) 283(89.3) 粒细胞升高类型 0.492 中性粒细胞 300(90.6) 12(85.7) 288(90.9) 嗜酸粒细胞 5(1.5) 0(0) 5(1.6) 嗜碱粒细胞 0(0) 0(0) 0(0) 淋巴细胞 12(3.6) 1(7.1) 11(3.5) 单核细胞 4(1.2) 0(0) 4(1.3) 无升高 10(3.0) 1(7.1) 9(2.8) 喉镜检查 会厌充血、肿胀 331(100.0) 14(100.0) 317(100.0) - 杓会厌皱襞肿胀 117(35.3) 6(42.9) 111(35.0) 0.575 声带充血 54(16.3) 4(28.6) 50(15.8) 0.257 舌扁桃体感染 21(6.3) 4(28.6) 17(5.4) 0.008 气道狭窄＞50% 71(21.5) 4(28.6) 67(21.1) 0.742 治疗 抗生素 41(12.4) 3(21.4) 38(12.0) 0.395 抗生素+糖皮质激素 290(87.6) 11(78.6) 279(88.0) 0.395 气管切开 1(0.3) 0(0) 1(0.3) - 环甲膜+气管切开 1(0.3) 0(0) 1(0.3) - 囊肿切除 21(6.3) 2(14.3) 19(6.0) 0.220 住院时间/d 5.4±2.0 6.0±2.5 5.2±2.0 0.169
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表 3 成人急性会厌炎复发的危险因素分析
危险因素 单因素分析OR(95%CI) P值 多因素分析OR(95%CI) P值 饮酒 从不 参考 参考 偶尔(＜2次/周) 1.367(0.259~7.223) 0.713 0.556(0.088~3.496) 0.531 经常(≥2次/周) 5.519(1.684~18.093) 0.005 0.133(0.030~0.589) 0.008 COPD 0.252(0.074~0.853) 0.027 6.030(1.304~27.890) 0.021 糖尿病 0.187(0.063~0.557) 0.003 7.036(1.772~27.933) 0.006 会厌囊肿 0.093(0.031~0.284) ＜0.001 7.466(1.997~27.907) 0.003 GERD/LPRD 0.244(0.081~0.733) 0.012 3.016(0.800~11.379) 0.103 舌扁桃体感染 0.142(0.040~0.499) 0.002 7.851(1.562~39.462) 0.012
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[1] Felton P, Lutfy-Clayton L, Smith LG, et al. A Retrospective Cohort Study of Acute Epiglottitis in Adults[J]. West J Emerg Med, 2021, 22(6): 1326-1334. doi: 10.5811/westjem.2021.8.52657
[2] Allen M, Meraj TS, Oska S, et al. Acute epiglottitis: Analysis of U.S. mortality trends from 1979 to 2017[J]. Am J Otolaryngol, 2021, 42(2): 102882. doi: 10.1016/j.amjoto.2020.102882
[3] Dowdy R, Cornelius BW. Medical Management of Epiglottitis[J]. Anesth Prog, 2020, 67(2): 90-97. doi: 10.2344/anpr-66-04-08
[4] Berger G, Landau T, Berger S, et al. The rising incidence of adult acute epiglottitis and epiglottic abscess[J]. Am J Otolaryngol, 2003, 24(6): 374-383. doi: 10.1016/S0196-0709(03)00083-8
[5] Wood N, Menzies R, McIntyre P. Epiglottitis in Sydney before and after the introduction of vaccination against Haemophilus influenzae type b disease[J]. Intern Med J, 2005, 35(9): 530-535. doi: 10.1111/j.1445-5994.2005.00909.x
[6] Shapira Galitz Y, Shoffel-Havakuk H, Cohen O, et al. Adult acute supraglottitis: Analysis of 358 patients for predictors of airway intervention[J]. Laryngoscope, 2017, 127(9): 2106-2112. doi: 10.1002/lary.26609
[7] Vaid P, Farrell E, Donnelly M. Predictors of airway intervention in acute supraglottitis(AS), a recent 7-year experience[J]. Am J Otolaryngol, 2021, 42(6): 103084. doi: 10.1016/j.amjoto.2021.103084
[8] Shaikh N, Nawaz S, Ahmad K, et al. Acute Adult Supraglottitis: An Impending Threat to Patency of Airway and Life[J]. Cureus, 2020, 12(8): e9976.
[9] Suzuki S, Yasunaga H, Matsui H, et al. Factors associated with severe epiglottitis in adults: Analysis of a Japanese inpatient database[J]. Laryngoscope, 2015, 125(9): 2072-2078. doi: 10.1002/lary.25114
[10] Bizaki AJ, Numminen J, Vasama JP, et al. Acute supraglottitis in adults in Finland: review and analysis of 308 cases[J]. Laryngoscope, 2011, 121(10): 2107-2113. doi: 10.1002/lary.22147
[11] Penella A, Mesalles-Ruiz M, Portillo A, et al. Acute infectious supraglottitis in adult population: epidemiology, management, outcomes and predictors of airway intervention[J]. Eur Arch Otorhinolaryngol, 2022, 279(8): 4033-4041. doi: 10.1007/s00405-022-07365-z
[12] Gagnon R, Bédard PM, Côté L, et al. Recurrent acute epiglottitis in adults: defective antibody response[J]. Ann Allergy Asthma Immunol, 2002, 88(5): 513-517. doi: 10.1016/S1081-1206(10)62391-5
[13] Hsu CM, Tsai MS, Yang YH, et al. Epiglottitis in Patients With Preexisting Autoimmune Diseases: A Nationwide Case-Control Study in Taiwan[J]. Ear Nose Throat J, 2021: 1455613211033689.
[14] Inghammar M, Rasmussen M, Linder A. Recurrent erysipelas--risk factors and clinical presentation[J]. BMC Infect Dis, 2014, 14: 270. doi: 10.1186/1471-2334-14-270
[15] Tsai YT, Huang EI, Chang GH, et al. Risk of acute epiglottitis in patients with preexisting diabetes mellitus: A population-based case-control study[J]. PLoS One, 2018, 13(6): e0199036. doi: 10.1371/journal.pone.0199036
[16] Yoon TM, Choi JO, Lim SC, et al. The incidence of epiglottic cysts in a cohort of adults with acute epiglottitis[J]. Clin Otolaryngol, 2010, 35(1): 18-24. doi: 10.1111/j.1749-4486.2009.02069.x
[17] Yousuf K, Lui B, Lemckert R, et al. Recurrent adult epiglottitis: contiguous spread from group A streptococcus lingual tonsillitis[J]. J Otolaryngol, 2006, 35(1): 65-67. doi: 10.2310/7070.2005.4119
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