呼吸道合胞病毒毛细支气管炎患儿尿白三烯测定及临床意义

目的 探讨呼吸道合胞病毒(RSV)毛细支气管炎(毛支)患儿尿白三烯E4(LTE4)的临床意义.方法 采用竞争性酶联免疫吸附试验技术检测20例健康婴儿和30例RSV毛支患儿急性期和恢复期的尿LTE4水平;采用潮气分析测定急性期患儿呼吸频率(RR)、达峰时间比(tPTEF/tE)及达峰容积比(vPTEF/vE),分析其与尿LTE4水平的相关性.结果 RSV毛支患儿急性期的尿LTE4比恢复期、正常健康组明显增高(P＜0.01),恢复期与正常健康组相比差异无统计学意义(P＞0.05);急性期毛支患儿潮气肺功能中RR增快、tPTEF/tE和vPTEF/vE下降,与正常健康组比较,差异有统计学意义(P＜0.0001);急性期尿LTE4浓度与RR呈正相关(r=0.4376,P=0.0126),与tPTEF/tE和vPTEF/vE呈负相关(r=-0.6895,-0.6636,P均＜0.001).结论 RSV毛支患儿尿LTE4增高,与肺功能指标呈负相关;尿LTE4浓度可作为RSV毛支临床诊治的非创伤性炎性指标.     

呼吸道合胞病毒毛细支气管炎患儿血和痰中白三烯测定及临床意义

目的 探讨呼吸道合胞病毒(respiratory syncytial virus,RSV)毛细支气管炎(毛支炎)患儿血、痰中白三烯C4(leukotriene C4,LTC4)水平的变化及临床意义.方法轻-中度毛支炎组22例,重度毛支炎组11例,另选择无喘息非RSV感染性肺炎患儿12例作为对照(肺炎组).采用双抗体夹心酶联免疫吸附试验测定血清和痰中LTC4水平,并进行对比分析.结果急性期轻-中度毛支炎组、重度毛支炎组、肺炎组血清LTC4水平分别为(76.96±28.19)pg/ml、(103.53±16.85)pg/ml、(18.14±7.49)pg/ml;痰中LTC4水平分别为(31.83±19.14)pg/ml、(67.11±15.11)pg/ml、(6.81±2.90)pg/ml;恢复期血清LTC4水平分别为(36.04±16.38)pg/ml、(52.27±17.03)pg/ml、(18.14±7.49)pg/ml,3组间差异有统计学意义(F=48.09,P＜0.001;F=15.50,P＜0.001;F=44.43,P＜0.001).治疗后轻-中度和重度毛支炎组血清LTC4水平明显降低,但仍高于肺炎组,差异有统计学意义(P＜0.05).结论RSV毛支炎患儿血和痰中LTC4水平明显增高,并与病情的轻重相关.     

A亚型呼吸道合胞病毒毛细支气管炎的临床研究

目的 了解呼吸道合胞病毒（ＲＳＶ）的亚型感染情况及其所致毛细支气管炎的临床特征。方法 （１）对１９９５年冬￣１９９７年春住院的８５例临床拟诊为毛细支气管炎的患儿进行鼻咽分泌物病毒培养、抗原检测及ＲＳＶ阳性分离株的单克隆抗体间接免疫荧光法亚型鉴定;（２）分析亚型感染病例的临床资料。结果 （１）共培养出ＲＳＶ２２株,阳性率为２６％,经鉴定全部为Ａ亚型株;（２）２２例Ａ亚型ＲＳＶ毛细支气管炎中幼婴（１￣     

呼吸道合胞病毒毛细支气管炎的并发症及危险因素

目的 研究呼吸道合胞病毒(RSV)毛细支气管炎(毛支)的并发症及危险因素。方法收集并分析我院5d～28个月RSV毛支213例患儿临床资料。结果 5d～6个月患儿并发症的发生率(65．45％)最高，而6个月～l岁并发症发生率明显高于1岁以上儿童；并中重度贫血的RSV毛支患儿易发生心力衰竭(65％)；早产儿RSV毛支患儿易并心力衰竭(57．89％)和呼吸衰竭(26．32％)。结论 RSV毛支易并心、脑、胃肠道损伤，贫血、早产、低龄等是并各器官损伤的危险因素。     

孟鲁司特钠对呼吸道合胞病毒毛细支气管炎的治疗作用

病毒是导致婴幼儿呼吸道感染最主要的病原体,其中呼吸道合胞病毒(RSV)占50%.RSV感染后呼吸道内半胱氨酰白三烯(CysLTs)除在急性期明显增高外,在急性期1个月内仍可维持在较高水平.呼吸道内CysLTs的持续高水平与患儿反复咳嗽、喘息,持续肺功能异常及哮喘发病率的增高密切相关.孟鲁司特钠为CysLTs特异性受体阻滞剂,可通过阻断CysLTs与其1型受体结合而发挥特异性抗炎作用.对于首次感染RSV的重症毛细支气管炎患儿,在急性期及4周内,每晚口服孟鲁司特钠4 mg,可有效改善急性期临床症状,防止肺功能下降,减轻持续性呼吸道高反应性,降低再次呼吸道RSV感染及反复咳嗽、喘息的发生率.     

呼吸道合胞病毒毛细支气管炎与支气管哮喘的相关性研究

目的探讨呼吸道合胞病毒(RSV)毛细支气管炎(毛支)与支气管哮喘两者发病机制的相关性。方法采用ELISA法检测31例RSV毛支患儿、25例支气管哮喘患儿、27例非RSV肺炎患儿和24例健康儿童外周血IFN-γ、IL-4、IL-10、TGF-β、IL-17水平,并进行比较分析。结果 RSV毛支患儿和哮喘患儿的IL-10、TGF-β水平显著低于非RSV肺炎患儿和健康对照儿童,而IL-4、IL-17水平则显著高于非RSV肺炎患儿和健康对照儿童(P均<0.05)。RSV毛支患儿和哮喘患儿的IFN-γ/IL-4、IL-10/IL-17比例显著低于非RSV肺炎患儿和健康对照儿童(P均<0.05),哮喘患儿的TGF-β/IL-17显著低于非RSV肺炎患儿与健康对照儿童(P均<0.05)。RSV毛支患儿与哮喘患儿之间、非RSV肺炎患儿与健康对照儿童之间IFN-γ、IL-4、IL-10、TGF-β、IL-17水平及其比值IFN-γ/IL-4、IL-10/IL-17、TGF-β/IL-17的差异均无统计学意义(P均>0.05)。结论 RSV毛支患儿与哮喘患儿存在相同的外周血细胞因子IFN-γ、IL-4、IL-10、TGF-β、IL-17水平的改变,这可能是其共同的发病机制之一。     

孟鲁司特钠治疗呼吸道合胞病毒毛细支气管炎的临床观察

目的 观察孟鲁司特钠对呼吸道合胞病毒毛细支气管炎患儿临床症状及预后的影响.方法 选择年龄6～12个月的毛细支气管炎患儿,均为首次发病,采用鼻咽分泌物定性检测呼吸道合胞病毒(RSV)抗原,阳性者作为研究对象,共80例,随机分为观察组和对照组各40例.两组患儿均采用相同的综合治疗,观察组加用孟鲁司特钠4 mg每晚1次口服.观察各组患儿临床症状恢复情况及住院天数;检测两组患儿入院第2天、第6天晨尿中的白三烯E4的含量;对所有病例随访3个月(观察组孟鲁司特钠持续应用3个月),观察各组患儿在此期间再次出现喘息的情况.结果 观察组达到喘息缓解所需时间及住院天数与对照组相比差异有统计学意义(P<0.01);两组患儿入院第2天、第6天晨尿中的白三烯E4的含量比较,治疗组在治疗前后及与对照组比较差异无统计学意义;随访3个月后,治疗组有3例出现再次喘息,而对照组有11例出现再次喘息.结论 呼吸道合胞病毒毛细支气管炎加用孟鲁司特钠可有效改善临床症状并缩短住院时间,降低病毒感染后喘息的复发率;两组尿白三烯含量差异无统计学意义,提示并非所有RSV感染的毛细支气管炎患儿喘息均与白三烯有关.     

T抑制细胞与婴幼儿呼吸道合胞病毒毛细支气管炎的关系探讨

本文应用免疫荧光法、以T细胞亚群单克隆抗体，研究婴幼儿呼吸道合胞病毒（RSV）毛细支气管炎急性期及感染后反覆喘鸣儿的T抑制细胞的变化。急性期CD3、CD4、CD5细胞均明显减少，出院时CD3细胞明显增多，CD4细胞呈升高趋势，CD3细胞变化极少。感染后反覆喘鸣儿CD8细胞亦呈低水平状态，与正常儿比较，均呈显著性差异（P＜0．01）。急性期RSV毛细支气管炎患儿与不伴喘鸣的RSV阴性患儿相比前者CD3、CD8量少，但不呈统计学差异（p>0.05)。实验提示T细胞免疫反应尤其是CD8细胞参与了RSV毛细支气管炎喘鸣的发病与转归。     

静脉滴注丙种球蛋白治疗呼吸道合胞病毒性毛细支气管炎的临床研究

72例呼吸道合胞病毒(RSV)所致的重症毛细支气管炎(简称毛支)患儿伴有血清IgG 下降,淋巴细胞增殖功能低下和外用血T 细胞数量减少.29例采用IVIG,治疗组与43例对照组比较,血清IgG、B细胞增殖功能、T_3~ 对细胞、T_4~ 细胞、对细胞、T_4/T_8比例均有明显提高;喘憋、肺部体征消失、胸片吸收时间及平均住院日也明显缩短,无不良反应及副作用.本文认为大剂量IVIG 对RSV 所致的毛支治疗,效果确切,安全可靠,为治疗本病开辟了新途径.     

呼吸道合胞病毒毛细支气管炎患儿T细胞亚群检测的临床价值

目的：呼吸道合胞病毒(RSV)感染所致的毛细支气管炎日后发展为哮喘的机率很高,由于哮喘患儿机体存在明显的免疫功能紊乱,而RSV毛细支气管炎在这方面的研究不多,为此该研究探讨毛细支气管炎患儿T细胞亚群的变化及其临床意义。方法：采用流式细胞术对21例RSV毛细支气管炎患儿及20例正常儿童T细胞亚群进行检测。结果：RSV毛细支气管炎组与对照组外周血T细胞亚群CD4,CD8差异无显著性(P>0.05),CD4/CD8比值RSV毛细支气管炎组高于对照组,差异有显著性(P<0.05)。结论：RSV毛细支气管炎患儿存在与哮喘相似的T细胞亚群变化相关的免疫功能紊乱,提示两者在发病机制上存在一定的联系。     

Multiple viral respiratory pathogens in children with bronchiolitis

Aim: The aim of the study was to describe the frequency of viral pathogens and relative frequency of co-infections in nasal specimens obtained from young children with bronchiolitis receiving care at a children's hospital.
Methods: We conducted a study of nasal wash specimens using real-time PCR and fluorescent-antibody assay results from children less than two with an ICD-9-CM code for bronchiolitis. All specimens were collected for clinical care at Children's Hospital in Seattle, WA, USA, during the respiratory season from October 2003 to April 2004.
Results: Viruses were detected in 168 (93%) of the 180 children with bronchiolitis. A single virus was identified in 127 (71%) children and multiple viruses in 41 (23%). Respiratory syncytial virus (RSV) was the most common virus detected (77%), followed by adenovirus (15%), human metapneumovirus (11%), coronavirus (8%), parainfluenza (6%) and influenza (1%). Of the 139 samples with RSV detected, 34 (24%) were co-infected with another viral pathogen.
Conclusion: Molecular diagnostic techniques identified a high frequency of viruses and viral co-infections among children evaluated for bronchiolitis. Further study of the role of viral pathogens other than RSV and co-infections with RSV in children with bronchiolitis appears warranted.     

Apnoea and bronchiolitis due to respiratory syncytial virus

ABSTRACT. A study was made of 146 children admitted to hospital with bronchiolitis due to respiratory syncytial virus. Fifteen subjects (10%) had apnoea. Six of the 16 infants (38%) less than two months of age had apnoea, compared with nine of 130 children (6.9%) over two months old (P<0.001). Nine of the 28 infants (32%) who were preterm had apnoea compared with six of 118 children (5.1%) over 37 weeks gestation (P<0.001).
Both early chronological age and prematurity are risk factors for the development of apnoea in children with RSV bronchiolitis.     

呼吸道合胞病毒毛细支气管炎与白细胞介素-10-592A/C基因多态性的相关性研究

目的 探讨白细胞介素-10-592A/C基因多态性与呼吸道合胞病毒(RSV)毛细支气管炎易感性、病情的关联和对血清白细胞介素(IL)-10的影响.方法 采用聚合酶链反应-限制性片段长度多态性检测100例汉族RSV毛细支气管炎患儿(病例组)和100例健康儿童(对照组)IL-10-592A/C位点单核苷酸多态性;应用ELISA法检测病例组血清IL-10水平.结果 病例组IL-10-592A/C位点基因型频率分别为AA 44%、AC 38%、CC 18%,等位基因频率分别为A 63%、C 37%;对照组基因型频率分别为AA 41%、AC 42%、CC 17%,等位基因频率分别为A 64%、C 36%;两组基因型及等位基因频率比较差异均无显著性(χ2=0.33,P>0.05;χ2=0.43,P>0.05).病例组IL-10-592A/C位点不同基因型患儿血清IL-10水平比较差异无显著性(F=0.87,P>0.05).IL-10-592A/C位点基因型频率在轻度和中重度患儿之间的差异无显著性(χ2=2.67,P>0.05).结论 IL-10-592A/C位点基因多态性与RSV毛细支气管炎不存在关联.     

Severe respiratory syncytial virus bronchiolitis in children: from short mechanical ventilation to extracorporeal membrane oxygenation

The objective of this study was to describe the characteristics of children who required mechanical ventilation (MV) or extracorporeal membrane oxygenation (ECMO) support for respiratory syncytial virus (RSV) bronchiolitis, and to identify risk factors associated with disease severity assessed by duration of MV, mortality and need for ECMO. Ventilated children under 1 year of age admitted for bronchiolitis were retrospectively studied over the 8-year period 1996–2003. The study population included 151 children. Of these, 38.4% were born prematurely and 8.6% had bronchopulmonary dysplasia (BPD). The mean age at initiation of MV was 61 days (±63 days). Infants were ventilated for a mean of 7.8 days (±7.5 days). Multivariate analysis revealed that prolonged duration of MV (>6 days, median value) was significantly associated with low gestational age ( P =0.02 for the group <32 weeks), requirement of neonatal oxygen supplementation ( P =0.03), BPD ( P =0.02) and positive tracheal aspiration culture ( P =0.004), in particular for Haemophilus influenzae ( P =0.03). Fourteen infants required ECMO with a mean period of MV before ECMO of 3.9 days (±4.5 days). Amongst these infants, the frequency of BPD was significantly higher as compared with the others ( P =0.001). Four infants died (survival rate 71.4%). The mean duration of ECMO for survivors was 12.1 days (±3.3 days). Conclusion:The data suggest that gestational age, requirement of neonatal oxygen supplementation, bronchopulmonary dysplasia and tracheal colonisation with Haemophilus influenzae are correlated with prolonged mechanical ventilation in children with bronchiolitis. Only bronchopulmonary dysplasia was associated with a need for extracorporeal membrane oxygenation that may provide lifesaving support in infants refractory to conventional management.     

INF-γ/A+874T位点基因多态性与呼吸道合胞病毒毛细支气管炎的相关性

目的：干扰素-γ(IFN-γ)分泌不足可能在严重呼吸道合胞病毒(RSV)感染的发病中发挥重要作用。IFN-γ/A+874T基因位点存在多态性,可能与RSV感染的病情存在关联。该研究分析INF-γ/A+874T基因位点在温州地区汉族儿童的分布特征;进一步探讨INF-γ/A+874T位点基因多态性与RSV毛细支气管炎易感性、病情的相关性及对鼻咽分泌物 INF-γ和血清总IgE水平的影响。方法：采用DNA测序法检测114例住院的汉族RSV毛细支气管炎患儿和90例汉族健康体检儿童INF-γ/A+874T位点基因多态性;采用酶联免疫吸附法测定鼻咽分泌物INF-γ水平,化学发光法测定血清总IgE水平。结果：两组均存在INF-γ/A+874T位点基因多态性,以AA纯合子基因型为主,其中RSV毛细支气管炎组AA、AT基因型频率分别为82.5%,17.5%,对照组分别为AA 77.8%,AT 21.1%,两组差异无显著性意义;病例组等位基因频率分别为A 90.4%,T 9.6%,对照组分别为A 88.3%,T 11.7%,两组差异均无显著性意义。轻度和中重度患儿INF-γ/+874位点2种基因型的差异亦无显著性意义。病例组2种基因型鼻咽分泌物INF-γ及血清总IgE水平差异均无显著性意义。结论：温州地区汉族儿童存在INF-γ/A+874T位点基因多态性,但未发现该位点变异与RSV毛细支气管炎易感性、病情、鼻咽分泌物INF-γ及血清总IgE水平存在关联。［中国当代儿科杂志,2009,11（1）：21-24］     

Use of permissive hypercapnia in the ventilation of infants with respiratory syncytial virus infection

We wished to retrospectively evaluate the effects of permissive hypercapnia (PHY) on barotrauma, mortality and length of stay when applied to ventilated infants with respiratory syncytial virus (RSV) bronchiolitis. Nineteen control infants with RSV induced respiratory failure were treated with conventional ventilation (April 1991–January 1994), after which time PHY was adopted as unit policy. A further 28 infants were then treated with PHY (January 1994–April 1996). Demographic and physiological data were collected from admission, and outcome variables including length of stay, barotrauma and mortality were recorded. The PHY group showed a significantly higher mean pCO₂ (7.6 vs 5.2 kPa), a lower mean pH (7.34 vs 7.40), and a reduction in maximal peak inspiratory pressures (25 vs 30 cmH₂O). Mortality, barotrauma, use of neuromuscular blockade and nosocomial infection did not differ between groups. There was a trend towards increased length of ventilation in the PHY group (median 7 vs 5 days). Conclusion Based on this retrospective data we can show no benefit for the use of permissive hypercapnia as a ventilatory strategy in this patient group. A prospective randomised controlled trial is warranted to accurately assess the outcome variables and cost implications of this strategy. Received: 22 June 1998 / Accepted in revised form: 25 August 1998     

Therapy for respiratory tract infections caused by respiratory syncytial virus

Respiratory syncytial virus (RSV) is the most common viral cause of lower respiratory tract infection (LRTI) in infancy and young children. No effective treatment for RSV lower respiratory tract infection (RSV-LRTI) exists. Ribavirin initially proved to be an effective anti-viral drug for RSV-LTRI. However, subsequently performed trials could not reproduce these positive results and, based on the current available evidence, there is no place for ribavirin in the routine treatment of RSV-LTRI. The use of nebulised bronchodilator therapy in RSV-LTRI has been subject of many trials, with conflicting results. Although the individual patient may have some short-term benefit from nebulised bronchodilators, there does not seem to be a sufficient scientific basis for the standard use of bronchodilator therapy in infants and children with RSV-LTRI. There is increasing evidence that RSV-LTRI is an immune-mediated disease and therefore corticosteroids may be an effective treatment. The results from efficacy trials have demonstrated that corticosteroids are not effective for patients with mild RSV infection. In contrast there are indications that it may be beneficial in patients with more severe RSV-LTRI. It has been demonstrated that in children with RSV infection the vitamin A concentration is inversely related to disease severity. The use of vitamin A in the treatment of patients with RSV-LTRI, however, proved not to be effective. Immunoprophylaxis with hyperimmune immunoglobulins and monoclonal antibody against the viral F-protein have been shown to be effective in the prevention of RSV-LRTI. From the results of the therapeutic efficacy trials, however, it can be discerned that immunoglobulins have no place in the treatment of RSV-LRTI. Conclusion Although respiratory syncytial virus infections each year have a considerable socioeconomic impact, attempts to find an effective therapy have so far been quite unsuccessful. Anti-viral therapy with ribavirin has not been proven to be effective. Symptomatic therapy with bronchodilators may give only short-term relief of symptoms in some individual patients, but has no effect on hospitalisation rates, or duration of hospitalisation. The beneficial effect of corticosteroids in patients with mild respiratory syncytial virus infection is very disappointing, however, there are indications that there might be an effect in patients with more severe infection. So far no beneficial therapeutic effect has been demonstrated with immune globulins. Received: 9 August 1999 / Accepted: 30 November 1999