中国耳鼻咽喉头颈外科2026，Vol.33Issue(7)：386-391,6.DOI:10.16066/j.1672-7002.2026.07.005
ACE腺样体内镜分级法的信效度验证及其在儿童阻塞性睡眠呼吸暂停中的应用研究
Reliability and validity of the endoscopic ACE adenoid grading system and its application in pediatric obstructive sleep apnea
摘要
Abstract
OBJECTIVE To validate the reliability and validity of the ACE endoscopic adenoid grading system and to explore its clinical value in the assessment of pediatric obstructive sleep apnea(OSA).METHODS A total of 231 children consecutively admitted to Beijing Children's Hospital from March 2022 to March 2023 were enrolled.All children underwent nasopharyngeal endoscopy and polysomnography.Five otolaryngologists independently graded adenoid morphology using the ACE adenoid grading system;repeated assessments were performed at an interval of 4 weeks.Inter-rater reliability was evaluated using Fleiss'Kappa test,and intra-rater test-retest reliability was evaluated using Cohen's Kappa test.Construct validity was analyzed in conjunction with clinical outcome measures.Binary and ordinal Logistic regression models were constructed with OSA status and OSA severity grading as dependent variables,respectively,to analyze the association between each dimension of the ACE system and pediatric OSA.RESULTS The inter-rater agreement of the ACE grading system was moderate to good(A:κ=0.499,C:κ=0.589,E:κ=0.626),and the intra-rater agreement was good to excellent(κ:0.693-0.964),indicating reliable psychometric properties.Significant differences in A,C,and E scores and the proportion of tonsillar hypertrophy were observed between the OSA and non-OSA groups(all P<0.01),demonstrating good construct validity.After adjusting for tonsillar grading,the A,C,and E scores showed no independent association with OSA occurrence(all P>0.05).However,the A score(χ²=11.59,P=0.009)and C score(χ²=6.96,P=0.031)were significantly associated with OSA severity,whereas the E score showed no significant association(P=0.907).CONCLUSION The ACE endoscopic adenoid grading system demonstrates good reliability,validity,and reproducibility in the Chinese pediatric population,enabling standardized assessment of adenoid morphology.The A and C dimensions can effectively predict OSA severity in children and are suitable for stratified disease management.The E dimension offers limited reference value for OSA assessment and may be appropriately simplified in clinical practice.关键词
儿童/睡眠呼吸暂停,阻塞性/预测/腺样体肥大/ACE分级法/信度及效度Key words
Child/Sleep Apnea,Obstructive/Forecasting/adenoid hypertrophy/ACE grading system/reliability and validity引用本文复制引用
李晓丹,王生才,龙婷,张丰珍,李宏彬,刘雨薇,刘笑歌,王桂香,王华,赵靖..ACE腺样体内镜分级法的信效度验证及其在儿童阻塞性睡眠呼吸暂停中的应用研究[J].中国耳鼻咽喉头颈外科,2026,33(7):386-391,6.基金项目
北京市高层次创新创业人才"登峰计划项目"(G20251057) （G20251057）
