呼吸道合胞病毒与淋巴细胞分化

RSV感染是婴幼儿常见的下呼吸道感染性疾病,但临床及转归与一般感染性炎性反应不同。婴幼儿期患过RSV感染的患儿50％～70％可反复喘息,甚至哮喘,推测RSV感染与哮喘发病机制上存在内在的联系。Th1功能成熟缓慢造成两种后果：一是患儿对感染易感,二是易发生对变应原的Th2反应,这在遗传上有特应性背景的儿童尤为明显。sCD86可能在哮喘的发病机制中发挥重要的调节作用,哮喘患者血清中的sCD86水平通过干扰CD28和B7分子的相互作用在哮喘反应中可能具有保护气道的作用,也可能通过同样的机制加重哮喘的病情,B7-CD28协同刺激信号在抗原激发的免疫反应中具有重要的调节作用。而CIY28／CTLA-4：B7是调节辅助性T细胞（n）细胞亚群分化最关键的共刺激信号,而且它对Th0细胞向Th1或Th2细胞分化的调节作用是不平衡的。它作用的异常可能导致Th1／Th2细胞的失衡而致病,sCTLA-4可能通过影响CD28／CTLA-4：B7共刺激信号而对Th1／Th2细胞因子平衡偏离产生影响。     

ELISA法检测呼吸道合胞病毒抗原、抗体方法学评价

目的：采用酶联免疫吸附试验（ELISA）方法。对早期呼吸道感染患者进行呼吸道合胞病毒（respiratory syneytial virus，RSV）抗原、抗体检测，评价ELISA法对RSV感染早期临床诊断意义。方法：对325例怀疑呼吸道合胞病毒感染的患者采用ELISA法进行抗原、抗体（IgA、IgG）检测，并对检测结果进行对比分析。结果：以患者本人急性期和恢复期RSV-IgG血清效价升高4倍者作为RSV近期感染的确诊依据，325例患者确诊RSV感染的患者为54例（16．62％），其中检出RSV-Ag阳性20例、RSV-IgA阳性34例，与确诊阳性符合率分别为83．33％和80．95％。结论：ELISA法检测RSV-Ag、RSV-IgA符合率高，检测结果快速、准确、可靠，两者同时检测，可作为临床早期诊断依据，ELISA法可作为检测呼吸道感染的主要方法。     

呼吸道合胞病毒所致下呼吸道感染的免疫机制和干扰素治疗

呼吸道合胞病毒所致下呼吸道感染的免疫机制和干扰素治疗包军综述苏渊何英审校（上海第二军医大学附属长征医院儿科，上海２００００３）ＴｈｅＰａｔｈｏｇｅｎｅｓｉｓａｎｄＭｉｎｉｓｔｒｔｉｏｎｏｆＩｎｔｅｒｆｅｒｏｎｉｎＬｏｗｅｒＲｅｓｐｉｒａｔｏｒｙＴｒａ...     

呼吸道合胞病毒的检测方法

呼吸道合胞病毒(RSV)是引起冬春季婴幼儿下呼吸道感染最常见、最重要的病原体之一,约50%的婴儿肺炎和90%的婴儿支气管炎均是因感染RSV所致;最新的研究发现免疫功能缺陷的成年人及老年人也是RSV的易感人群[1-2].目前尚无有效的RSV疫苗面世.因此,快速、准确的RSV检测技术不仅对监测与控制RSV流行具有十分重要的意义,而且能为临床早期诊断提供可靠的实验室依据,也是合理选择治疗方案的基础[3].了解呼吸道合胞病毒检测手段和开展快速病毒检测,已成为当务之急.本文就RSV的检测方法作一简要综述.     

呼吸道合胞病毒快速诊断方法探讨

呼吸道合胞病毒(RSV)是婴幼儿下呼吸道感染之重要致病原之一。每年因RSV感染而需住院治疗的婴幼儿为数不少。故此,为使患儿得到恰当的治疗,需要有RSV的快速诊断方法。本室自1981年开始,建立了间接免疫荧光法(IF)检测RSV。尽管IF具有快速敏感等优点,但需有费用昂贵的荧光显微镜,故不适用于基层医院之推广应用。所以,我们又建立了酶联免疫吸附试验(ELISA)及碱性磷酸酶-抗碱性磷酸酶桥联酶标试验(APAAP)。本文报告这三种方法与病毒分离结果之比较。     

呼吸道合胞病毒肺炎观察与护理

呼吸道合胞病毒 (RSV)肺炎是婴幼儿肺炎中较常见的一种类型 ,寒冷季节呈流行性发生。 2岁以下婴幼儿 ,起病急骤 ,往往很快出现喘憋性呼吸困难及低氧血症。我科 2 0 0 0年 1月～ 2 0 0 0年 1 2月共收治肺炎病儿 1 2 0 0名 ,对确诊为RSV肺炎的患儿1 1 0例进行了特色护理 ,现报告如下。1　资料与分析1 1 0例患儿中 ,男 6 2例 ,女 4 8例 ,年龄 1个月～ 3岁 ,其中 1个月～ 6个月的 6 1例 ,占 5 5 .5 % ;7个月～ 2岁的 39例 ,占 35 .5 % ;>2岁的 1 0例 ,占9.0 %。入院时大多出现呼吸急促 ,喘憋明显 ,唇周紫绀。实验室检查 :白细胞计数在 (4～ 1…     

呼吸道合胞病毒抗体检测在早期感染诊断中的应用

目的 探讨呼吸道合胞病毒（RSV）抗体检测在早期感染诊断中的应用。方法 选择2020年1月—2023年1月平邑县人民医院收治的650例疑似RSV感染者作为研究对象。采用间接荧光免疫法检测RSV,以患者急性期（发热、呼吸困难、发绀,持续数天至数周）与恢复期（症状减轻,炎症消退,持续数周到数月）RSV-免疫球蛋白G(IgG)血清效价升高4倍作为RSV感染的判定标准。结果 650例患者中,252例进行了呼吸道合胞病毒抗原（RSV-Ag）检测,检出阳性样本49例,阳性率为19.44%;398例进行了RSV-免疫球蛋白A(IgA)检测,检出阳性样本85例,阳性率为21.36%。以RSV-IgG血清效价升高4倍为阳性判断依据,可见检出RSV-Ag阳性样本41例,符合率为83.67%;检出RSV-IgA阳性样本69例,符合率为84.18%。结论 RSV的检出与早期RSV感染有较高的符合率,间接荧光免疫法的检测结果准确可靠,同时检测RSV-Ag与RSV-IgA能够提高RSV感染的早期诊断率。     

小儿呼吸道合胞病毒免疫反应的研究进展

呼吸道合胞病毒(RSV)是引起下呼吸道感染的主要病毒因素,有较高的发生率和一定的死亡率,且RSV感染可能会对肺部发育产生不良影响,导致感染后易出现喘息、哮喘和气道高反应性.目前治疗上以支持性治疗为主,尚无安全有效的特异抗病毒治疗方法.宿主免疫反应失调可能在该疾病严重程度分布中起着重要作用.本文就近年小儿RSV免疫反应研...     

呼吸道合胞病毒在中国的流行季节

呼吸道合胞病毒（ＲＳＶ）是最严重的下呼吸道感染的病毒病原。它导致世界性的婴幼儿肺炎和支气管炎。１９５６年Ｗｏｒｒｉｓ首次从患有呼吸道症状的黑猩猩身上分离出ＲＳＶ,次年Ｃｈａｎｏｃｋ等人从２名患有下呼吸道疾病的婴儿体内分离到相同的病毒ＲＳＶ。从此,世界...     

A review of palivizumab and emerging therapies for respiratory syncytial virus

Introduction: Respiratory syncytial virus (RSV) is an important pathogen in children and adults; however, current treatment options are primarily supportive. Palivizumab, the only approved specific monoclonal antibody for RSV is used prophylactically to reduce morbidity in a select population of high-risk children.

Areas covered: The development and current use of palivizumab; the potential role of palivizumab as preventive therapy in patients with cystic fibrosis, asthma and compromised immune systems; and explores the limited research in which palivizumab has been used for treatment of RSV. The modified recommendations for the use of palivizumab espoused by the American Academy of Pediatrics and research on the cost-effectiveness of this product are presented. In addition, the authors discuss the development of enhanced monoclonal antibodies including motavizumab, which was recently denied FDA approval for preventative therapy. The authors explore the historical and current efforts to develop a vaccine targeting RSV. The current status of antiviral drug development is also reviewed. The literature search included RSV-Ig, palivizumab, and emerging drugs and vaccines for the treatment of RSV as keywords and titles from 1997 to 2011.

Expert opinion: Although there are potential drugs and vaccines in development to prevent or reduce the effects of RSV infection, palivizumab remains the only licensed product to reduce the severity of disease in high-risk pediatric patients.     

Motavizumab for the prevention of respiratory syncytial virus infection in infants

Background: Respiratory syncytial virus (RSV) is the most important respiratory viral pathogen of infancy. The only unequivocally effective pharmacological compound for the management of RSV infection is palivizumab, a monoclonal antibody against the fusion protein of RSV. Recently, motavizumab, a similar but more potent monoclonal antibody, has been developed and tested against palivizumab. Objective: In this review, we summarize data comparing the safety and efficacy of the two monoclonal antibodies in prevention of RSV infection. Other therapeutic options also are discussed. Methods: We reviewed all published articles listing motavizumab or palivizumab in the title or keywords. Results/conclusion: In a large comparative clinical trial for which peer review is pending, motavizumab proved noninferior to palivizumab for prevention of RSV-related hospital admission in infants with underlying conditions placing them at high risk for hospitalization after RSV infection. In this trial, motavizumab in comparison to palivizumab significantly reduced the severity of illness among those infants hospitalized with RSV infection, as well as the number of outpatient lower respiratory infections caused by RSV. Safety profiles of each of the two compounds were excellent. Based on these data, motavizumab should eventually replace palivizumab in the prevention of RSV infection.     

黄芩苷抗呼吸道合胞病作用的研究

目的研究黄芩苷对呼吸道合胞病毒(RSV)感染的BALB/c小鼠干扰素(IFN)-α及IFN-β表达的干预作用,探讨其抗病毒机制。方法建立BALB/c小鼠呼吸道合胞病毒感染模型,采用酶联免疫吸附试验(ELISA)法检测小鼠肺组织IFN-α及IFN-β的水平。结果黄芩苷能明显增加RSV感染BALB/c小鼠的IFN-α及IFN-β的表达。结论黄芩苷在小鼠体内可以通过调控IFN的表达来发挥抗RSV的作用。     

呼吸道合胞病毒A与B亚型多重荧光PCR检测方法的建立及应用

目的建立一种新的呼吸道合胞病毒(RSV)分型检测方法,用于快速检测和监测。方法针对RSV G基因设计引物、探针,并引入人β-actin基因(ACTB)作为内参质控,建立RSV-A、RSV-B多重荧光PCR检测方法。使用多种常用呼吸道病原体及体外转录RNA产物考核其特异性和灵敏度。并对2015年1月至12月广州两家医院的儿童急性呼吸道感染患者进行检测。结果所建立的多重检测方法未见非特异性反应。RSV-A、RSV-B和ACTB分别可检测低至4、8和12 copies/μL的RNA模板,且分别在10~1×10~(10)copies/μL、100~1×10~(10)copies/μL和100~1×10~(10)copies/μL时具备良好的线性关系,线性相关系数r2均大于0.99。儿童急性呼吸道感染患者监测中,RSV-A为期间优势亚型。结论本研究所建立的RSV-A、RSV-B多重荧光PCR检测方法,具有较好的特异性、灵敏度、可操作性,可用于相关研究。     

Steroid-responsive subacute polymyositis in an adult following respiratory syncytial virus infection

The role of viral infections in the aetiopathogenesis of polymyositis remains speculative. We report a case of profound subacute polymyositis with incipient ventilatory failure following serologically confirmed infection by respiratory syncytial virus (RSV), with a dramatic and sustained response to pulse corticosteroid therapy. We suggest a possible autoimmune mechanism to account for this sequence of events.     

Overview of prevention and management of acute bronchiolitis due to respiratory syncytial virus

ABSTRACT

Introduction: Respiratory Syncytial Virus (RSV) is the most common cause of Acute Bronchiolitis (AVB) in infants. AVB causes significant morbidity and mortality worldwide, most deaths occurring in the developing world. AVB causes respiratory distress in infants, leading to respiratory failure in some cases. Disease is more severe in infants with risk factors, such as prematurity, chronic cardiac and lung disease and immunodeficiency.

Areas covered: Despite major advances in supportive care in the developed world, which has led to a significant reduction in mortality, treatment remains symptomatic and supportive. No specific antiviral treatment has yet proven to be effective. Prevention of disease with monoclonal antibodies has proven to reduce illness severity in those with risk factors, however, this is prohibitively expensive, particularly for the developing world.

Prospects for vaccine development are improving. However, because most disease is in young infants, maternal immunization is necessary. However, due to the transient nature of RSV immunity and the circulation of multiple subtypes, vaccines proven to be effective in adult challenge models have yet to be translated to protection in infants.

Expert commentary: Despite advances in preventative treatments, adherence to evidence-based guidelines provides the best prospect for successful reduction in morbidity and mortality.     

呼吸道合胞病毒RNA及IgM在小儿呼吸道感染诊断中的应用价值

目的探讨呼吸道合胞病毒RNA(RSV-RNA)及呼吸道合胞病毒IgM(RSV-IgM)在小儿呼吸道感染诊断中的应用价值。方法选取2015年9月至2017年4月确诊呼吸道合胞病毒感染患儿56例,收集其咽部分泌物标本,对RSV-RNA进行检测;另抽取患儿空腹静脉血,对RSV-IgM进行检测,对两者的阳性检出率及与年龄、发病时间的相关性进行统计学分析。结果 RSV-RNA、RSV-IgM阳性检出率分别为89.29%、32.14%,RSV-RNA的阳性检出率显著高于RSV-IgM,差异有统计学意义(P0.05)。≤6个月,6个月至1岁患儿的RSV-RNA阳性检出率均高于RSV-IgM(P0.05);发病时间≤7d的患儿RSVRNA的阳性检出率高于RSV-IgM(P0.05)。结论在小儿RSV感染检测中,检测RNA比IgM具有更高的准确性,尤其是对年龄≤1岁、发病时间较短(≤7d)的患儿,早期诊断具有重要指导作用。     

江苏省常州地区急性呼吸道感染患儿呼吸道合胞病毒流行病学特点

目的探讨常州地区急性呼吸道感染（ARTI）患儿呼吸道合胞病毒（RSV）的流行病学特点。方法选取2011年1月—2012年12月在本院就诊的ARTI患儿3483例。采集患儿鼻咽分泌物,直接免疫荧光法检测RSV病毒抗原。结果所有患儿中共检出RSV阳性标本627例,总阳性率为18.00%（627/3843）,其中2011年阳性率为22.96%（306/1333）,2012年阳性率为14.93%（321/2150）,2011年RSV感染率明显高于2012年,差异有统计学意义（χ2=35.904,P=0.000）。男孩RSV感染率明显高于女孩。随年龄的增加,RSV感染率逐渐下降,新生儿感染率最高。RSV流行高峰期在每年的冬春季节,且毛细支气管炎患儿为好发人群。结论 RSV是常州地区ARTI患儿的重要病原体,3岁以内儿童多见,好发于冬春季,在毛细支气管炎患儿中检出率最高。     

儿童呼吸道合胞病毒肺炎流行特征分析

目的 探讨小儿呼吸道合胞病毒肺炎流行特征,为有效防治提供依据.方法 采用描述流行病学方法对2005年11月至2006年1月住院的肺炎患儿资料进行分析.结果 386名住院患儿经直接免疫荧光法病原学确诊204名,其中3例腺病毒抗原阳性,占1.47%;3例流感A型病毒抗原阳性,占1.47%;198例呼吸道合胞病毒抗原阳性,占97.05%.＜1岁组占64.14%;男女性别比为2:1;无明显的聚集性.结论 冬春季小儿肺炎以呼吸道合胞病毒肺炎多发,应加强监测和防治.