儿童呼吸道人类偏肺病毒呼吸道合胞病毒和流感病毒感染的临床特征比较

目的 了解人类偏肺病毒(hMPV)在苏州地区儿童呼吸道感粢中的感染情况;比较hMPV、呼吸道合胞病毒(RSV)和流感病毒(Inf)引起呼吸道感染的临床特征.方法 选取2005年11月至2006年10月苏州大学附属儿童医院呼吸科1932例急性呼吸道感染住院患儿.采用无茵负压吸引法采集新鲜痰液.直接免疫荧光法检测RSV,腺病毒,Inf A、B型,副流感病毒1、2、3型等7种常见呼吸道病毒;同时用逆转录.聚合酶链反应法(RTPCR)检测hMPV N基因,随机挑选部分阳性PCR扩增产物进行核苷酸测定并将所测序列进行比较分析.结果 1932例标本中hMPV阳性例数为128例(6.6%),其中hMPV合并其他呼吸道病毒感染5例(3.9%);hMPV检测阳性率在冬季呈现高峰;hMPV感染患儿的平均年龄为22.17月龄,较RSV和Inf感染患儿大;hMPV感染者临床特征与RSV和Inf感染相似,喘息在RSV和hMPV感染患儿中更为多见,发热则更多见于hMPV和Inf感染患儿.RSV感染后所致的首要疾病是毛细支气管炎,hMPV和Inf感染后所致的首要疾病是肺炎.单纯hMPV与hMPV合并其他呼吸道病毒感染临床表现差异无统计学意义(P＞0.05).结论 苏州地区部分儿童的呼吸道感染与hMPV有关;hMPV感染临床特征无特异性;hMPV在合并其他呼吸道病毒感染时并不加重病情.     

呼吸道合胞病毒急性下呼吸道感染患儿的细胞免疫变化

呼吸道合胞病毒急性下呼吸道感染患儿的细胞免疫变化陈宗波，董永绥，赖丽霖呼吸道合胞病毒（ＲＳＶ）是引起小儿急性下呼吸道感染（ＡＬＲＩ）的重要病原。有关小儿ＲＳＶＡＬＲＩ时细胞免疫变化的多项指标综合报道国内不多，亦无对Ａ、Ｂ亚型ＲＳＶ感染进行观察，我们对...     

呼吸道合胞病毒和鼻病毒所致呼吸道感染的临床表现

呼吸道感染在婴纺儿中很普遍,占儿科就诊和住院病例的大多数,其中30～50%是由病毒所引起。呼吸道合胞病毒(RSV),无疑是婴儿及幼儿最主要的病毒病原体,经常引起严重的毛细支气管炎和肺炎。在流行期,首次感染的患病率可高达98%。成人的上呼吸道感染约30%是由鼻病毒(RV)引起。然而,对于RV 在婴幼儿中引起感染的临床情况却知之甚少。在最近的一项调查中,我们证明了RV 是住院婴幼儿下呼吸道感染中仅次于RSV 的最常见原因。资科及方法1984年9月～1986年6月,在519例(男315例,女204例)各种急性呼吸道感染患儿的鼻咽分泌液中筛查呼吸道病毒病原体。患儿年龄10天～3岁(平均6.6月)。471例(91%)为住院患儿,48例,(9%)为门诊患儿。112例(21%)为上呼吸道感染,342例(66%)为下呼吸道感染,65例(13%)呼吸道感染并非就诊原因。所有病例均有急性呼吸道     

急性下呼吸道感染患儿呼吸道合胞病毒及其亚型的检测及分析

目的　总结呼吸道合胞病毒(RSV)在其流行季节的亚型分布情况;探讨RSV亚型和临床疾病严重程度的相关性。方法　采用RT PCR 酶联夹心杂交法检测了2 0 0 2年1 0月至2 0 0 3年3月和2 0 0 3年1 0月至2 0 0 4年3月连续两年冬春季期间就诊于温州医学院附属儿童医院的2 0 2例急性下呼吸道感染的婴幼儿鼻咽部分泌物中RSV及其亚型;结合临床资料,对临床症状和体征进行疾病严重程度评分。结果　2 0 2例标本中RSV阳性共1 2 3例,阳性检出率为60 . 9% ;两个冬春季都以RSVA亚型为主,2 0 0 2～2 0 0 3年冬春季A亚型占RSV阳性标本中76 7% ,2 0 0 3～2 0 0 4年占82. 0 % ;通过对97例A亚型和2 6例B亚型病例临床资料的评估,发现B亚型引起的临床症状和体征更重(P <0. 0 5)。结论　RSV是引起冬春季婴幼儿急性下呼吸道感染的最主要的病原体;以A亚型为主,但B亚型引起的临床表现更严重。     

急性下呼吸道感染住院患儿呼吸道合胞病毒感染分析

目的了解急性下呼吸道感染（acutelowerrespiratoryinfection,ALRI）住院患儿呼吸道合胞病毒（respiratorysyncytialviruS,RSV）感染的情况。方法对2010年1月至2013年3月2625例ALRJ住院患儿采用直接免疫荧光法检测其鼻咽分泌物中的RSV抗原。结果送检标本2625例,RSV阳性534例（20．34％）。〈1岁组RSV阳性检出率24．30％（399／1642）,一3岁组15．83％（114／720）,〉3岁组7．98％（21／263）,〈1岁与～3岁组比较（x2=21．102,P〈0．01）,-3岁与〉3岁组比较（X2=10．016,P〈0．01）,差异均有统计学意义。男性患儿RSV阳性检出率21．49％（331／1540）,女性18．71％（203／1085）,男性检出率高于女性（x2=4．579,P〈0．05）。不同年度RSV阳性检出率差异无统计学意义。RSV检出率高峰从每年的10月开始,至次年的4月结束。结论ALRI住院患儿RSV阳性检出率以1岁以内婴儿最高,年龄越小,RSV感染率越高,男性RSV感染高于女性,冬春季为流行高峰。     

人类偏肺病毒在儿童呼吸道感染中的研究进展

人类偏肺病毒(hMPV)是一类新近发现的病毒,与儿童,特别是婴幼儿的呼吸道感染关系密切,可以引起上下呼吸道感染.目前研究发现,hMPV感染在世界范围的传播越来越广,且在儿童中感染率有不断上升的趋势,所以对hMPV进行深入研究有利于查明儿童呼吸道感染的病因,对儿童呼吸道感染的防治有重要意义.     

急性呼吸道感染患儿鼻咽分泌物中呼吸道合胞病毒亚型的检出分析

目的探讨急性呼吸道感染患儿呼吸道合胞病毒(RSV)亚型的流行规律。方法应用直接免疫荧光法筛检2006年1月至2012年12月苏州地区42 208份来自急性呼吸道感染住院患儿的鼻咽分泌物标本的RSV病毒抗原;随机抽取不同年份RSV流行季节的RSV阳性标本,采用实时荧光PCR鉴定亚型。结果 RSV流行呈季节性,当年11月至次年3月为高峰期,而当年5至9月为RSV检出低谷期;从2006年至2012年,不同年份间高峰期的RSV阳性检出率差异有统计学意义(χ2=280.09,P0.01)。在398份不同年份高峰期的RSV抗原阳性标本中,检出A亚型319份(80.15%),B亚型63份(15.83%),未检出16份(4.02%),不同年份高峰期之间RSV亚型分布的差异有统计学意义(P0.01)。多数年份RSV流行以A亚型为主,在高峰期RSV检出率最低的2008—2009年A、B亚型同时流行,随后的2009—2010年以B亚型为主。结论苏州地区2006年至2012年,前四个流行季RSV检出率呈现周期性隔年增高趋势,之后两个流行季RSV感染呈持续高发趋势,急性呼吸道感染住院患儿RSV以A亚型为主。     

急性下呼吸道感染患儿病毒病原学分析

目的了解昆明地区小儿急性下呼吸道感染(ALRI)患儿病毒病原谱及病毒病原学流行特点。方法对昆明市儿童医院内科2005-10—2006-09,临床诊断为急性下呼吸道感染712例住院患儿鼻咽分泌物,应用直接免疫荧光法进行呼吸道合胞病毒(RSV)、腺病毒(ADV)、流感病毒(IVA、B型)、副流感病毒(PIV1、2、3型)7种病毒抗原检测,并对呼吸道病毒流行特点进行分析。结果712例ALRI患儿中检出阳性病例206例,阳性率28.93%。新生儿、婴儿占阳性病例的77.18%。阳性标本中检出RSV177株,占阳性标本的85.92%(177/206),其次为PIV2、ADV各9株分别占4.37%(9/206),检出PIV35株占2.43%(5/206)、IVA、PIV1各3株占1.46%(3/206),一年中未检出IVB病毒株。206例阳性患儿中新生儿、婴儿、幼儿RSV感染阳性率分别为27.18%、42.23%、16.51%,年龄组间RSV阳性率比较,差异存在统计学意义。婴儿组中检出混合感染阳性病例3例,其中RSV合并ADV感染2例,PIV2合并ADV感染1例。RSV高峰流行季节在每年7月至次年2月,流行季节持续近8个月,3～6月病毒感染阳性率呈下降趋势,呼吸道病毒感染流行具有明显季节性。结论RSV是昆明地区婴儿ALRI的主要病原,呼吸道病毒类型及病原流行季节存在地区差异。     

双黄连雾化吸入治疗呼吸道合胞病毒所致急性下呼吸道感染

为评价双黄连雾化吸入对呼吸道合胞病毒（RSV）所致急性下呼吸道感染的疗效，采用双盲随机对照方法对45例3岁以下有RSV感染的肺炎或毛细支气管炎病例进行了治疗研究。双黄连组17例，病毒哩组和对照组各14例。结果表明，治疗后双黄连组及病毒唑组在症状体征缓解天数方面均短于对照组（F=5.12，P＜0．01）；血氧分压的改善双黄连组显著高于其他两组（F=4.31，P＜0．05）；肺部X线检查结果双黄连组也短于其他两组（H=11.01，P＜0．01）。双黄连组病毒检出率较低，细胞免疫指标恢复正常者亦较其他两组多。双黄连组未见任何严重副作用。研究结果提示，双黄连雾化吸入治疗RSV引起的下呼吸道感染是安全有效的方法。     

Correlation between respiratory syncytial virus (RSV) test data and hospitalization of children for RSV lower respiratory tract illness in Florida

BACKGROUND: Florida experiences year-round outbreaks of respiratory syncytial virus (RSV), but it is unknown if there is a correlation between RSV virology data and disease-related hospitalizations. We analyzed RSV surveillance and hospitalization data for the state of Florida to determine if there is an association between seasonal virology data and the incidence of International Classification of Diseases, 9th revision, clinical modification (ICD-9-CM) coded hospitalizations for RSV lower respiratory tract illness. METHODS: We conducted a retrospective analysis for each of 5 regions of Florida for 4 years (2001-2004) of monthly RSV surveillance data presented on the Florida Department of Health website and hospitalization data provided by the Agency for Health Care Administration. RSV was considered present when > or =10% of laboratory tests were positive in a given month and the duration of seasons was determined by the number of consecutive months threshold values were exceeded. Hospitalizations in children 24 months of age and younger were defined as RSV related if any of the following RSV-specific ICD-9-CM codes appeared on the discharge summary: 079.6 RSV; 466.11 acute bronchiolitis caused by RSV; and 480.1 pneumonia caused by RSV. RESULTS: RSV circulated year-round statewide and seasons ranged from 7-8 months in the southwest, northwest, and north regions of Florida to 11-12 months in the central and southeast regions, respectively. More than 23,000 children younger than 24 months of age were hospitalized throughout the state for an RSV-related illness during the 4-year period, with almost 20,000 (86%) of the admissions in infants less than 12 months of age. There were 23 hospitalizations yearly per 1000 births and more than 90% of discharges occurred during the defined RSV seasons. CONCLUSIONS: To our knowledge, this is the first study to demonstrate a positive correlation between RSV test data and hospitalizations both statewide and for individual regions within Florida. It would be prudent for clinicians to obtain results of local RSV virology data to guide decisions on timing of prophylaxis to prevent RSV hospitalizations.     

Diminished lung function, RSV infection, and respiratory morbidity in prematurely born infants

Background

Diminished lung function appears to be a risk factor for respiratory syncytial virus (RSV) infection/bronchiolitis in term born infants.

Aims

To determine if diminished lung function prior to neonatal unit discharge was associated with subsequent symptomatic RSV lower respiratory tract infection (LRTI) and respiratory morbidity in prematurely born infants.

Methods

Of 39 infants in a tertiary neonatal intensive care unit (median gestational age 28 weeks, range 23–31), 20 had bronchopulmonary dysplasia. Lung function (compliance and resistance of the respiratory system (C_rs and R_rs) and functional residual capacity (FRC)) was measured on the neonatal unit at 36 weeks postmenstrual age (PMA). Following neonatal unit discharge, nasopharyngeal aspirates were obtained on every occasion, at home or in hospital, an infant had an LRTI. RSV was identified by immunofluorescence and/or culture.

Results

The 15 infants who suffered a symptomatic RSV LRTI had a higher mean R_rs and suffered more wheeze at follow up than the rest of the cohort. Regression analysis showed that a high R_rs was significantly associated with a symptomatic RSV LRTI; significant factors for cough were a high R_rs and a symptomatic RSV LRTI, and for wheeze were a high R_rs.

Conclusion

Prematurely born infants, who had a symptomatic RSV LRTI and/or respiratory morbidity at follow up, had worse lung function prior to neonatal unit discharge.     

Diminished lung function, RSV infection, and respiratory morbidity in prematurely born infants.

BACKGROUND: Diminished lung function appears to be a risk factor for respiratory syncytial virus (RSV) infection/bronchiolitis in term born infants. AIMS: To determine if diminished lung function prior to neonatal unit discharge was associated with subsequent symptomatic RSV lower respiratory tract infection (LRTI) and respiratory morbidity in prematurely born infants. METHODS: Of 39 infants in a tertiary neonatal intensive care unit (median gestational age 28 weeks, range 23-31), 20 had bronchopulmonary dysplasia. Lung function (compliance and resistance of the respiratory system (C(rs) and R(rs)) and functional residual capacity (FRC)) was measured on the neonatal unit at 36 weeks postmenstrual age (PMA). Following neonatal unit discharge, nasopharyngeal aspirates were obtained on every occasion, at home or in hospital, an infant had an LRTI. RSV was identified by immunofluorescence and/or culture. RESULTS: The 15 infants who suffered a symptomatic RSV LRTI had a higher mean R(rs) and suffered more wheeze at follow up than the rest of the cohort. Regression analysis showed that a high R(rs) was significantly associated with a symptomatic RSV LRTI; significant factors for cough were a high R(rs) and a symptomatic RSV LRTI, and for wheeze were a high R(rs). CONCLUSION: Prematurely born infants, who had a symptomatic RSV LRTI and/or respiratory morbidity at follow up, had worse lung function prior to neonatal unit discharge.     

Comparison between US and MRI in the prenatal assessment of lung malformations

Background

The contribution of MRI in the prenatal evaluation of congenital lung abnormalities (CLA) has not been extensively investigated.

Objective

(1) To compare diagnostic accuracy and assessment of prognostic factors between US and MRI in CLA and (2) to assess the diagnosis agreement between prenatal imaging and postnatal diagnosis.

Materials and methods

We included 23 consecutive fetuses who underwent concomitant US and MRI during gestation as well as postnatal CT and surgery (n = 22).

Results

US-MRI sets were performed at median gestational age of 26 (n = 16) and 34 (n = 22) weeks. Postnatal diagnoses were 11 congenital pulmonary airway malformations (CPAM), 4 bronchopulmonary sequestrations (BPS), 6 hybrid lesions and 2 cysts. US and MRI agreement was significantly better during the second trimester than during the third one (P = 0.02). Disagreements were related to missed cysts (n = 5), mediastinal shift (n = 6) and vessels (n = 5). US and MRI diagnosis agreement was present in 20 cases, including 5 cases of misdiagnosis. US and MRI were concordant with postnatal diagnosis in 17 and 16 cases, respectively.

Conclusion

In our series, no clear superiority of MRI over US in the prenatal evaluation of CLA was demonstrated, but US better demonstrated systemic feeding vessels and MRI cysts and normal lung adjacent to the lesion.     

Relationship between the chest radiograph, regional lung function studies, exercise tolerance, and clinical condition in cystic fibrosis

This study evaluated the accuracy of the interpretation of the chest film in delineating localised abnormalities of ventilation and perfusion, as well as the overall severity of airways obstruction, exercise tolerance, and clinical condition in children with cystic fibrosis. Radiographic findings in various regions of the chest film were compared with the functional values obtained with regional lung function tests which evaluated the arrival and disappearance of boluses of radioactive nitrogen given by inhalation and infusion. While the more severely affected areas on the chest radiograph were found to correlate with similar regions on the lung function tests, as did overall scores, errors occurred in some cases if the x-ray film alone was used as a judge of regional physiological derangement. In addition the degree of airways obstruction, the exercise tolerance on a cycle ergometer, and clinical grading, each correlated significantly with the radiographic score. We conclude that the chest radiograph is a good indicator of the overall severity of the lung disease and that it correlates well with exercise tolerance and clinical condition in cystic fibrosis.     

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目的探究儿童哮喘控制测试(C-ACT)评分与哮喘患儿肺功能及气道反应性的相关关系。方法对2009年10月至2010年5月在重庆医科大学附属儿童医院哮喘门诊就诊的273例哮喘患儿,测量肺功能并同时完成C-ACT评分,以第1秒用力呼气流量占预计值百分比(FEV1%)和最大呼气流量占预计值百分比(PEF%)作为通气功能指标与C-ACT进行相关性分析;根据乙酰甲胆碱激发实验将气道反应性分为重度、中度、轻度和极轻度4级,比较各级间C-ACT得分及大小气道通气功能指标的差异,研究C-ACT与通气功能及气道反应性的关系。结果 C-ACT与FEV1%、PEF%的相关系数分别为0.25和0.34(P<0.01),去除就诊前4周患上呼吸道感染和小于7岁的患儿后,其相关系数分别为0.42和0.52(P<0.01);气道反应性重度和极轻度组间C-ACT得分差异有统计学意义(P<0.01),中度和轻度组间差异无统计学意义(P>0.05)。结论 C-ACT评分与哮喘患儿通气功能、气道反应性有较好的相关性,就诊前4周内是否患有上呼吸道感染和年龄是影响其相关性的两个主要因素。     

The relationship between RSV bronchiolitis and recurrent wheeze: the chicken and the egg

Respiratory syncytial virus bronchiolitis is the most frequent cause of infant hospitalization. RSV bronchiolitis is often followed by recurrent episodes of wheeze. Pathogenesis of RSV bronchiolitis as well as post-bronchiolitis wheeze are incompletely understood. The aim of this review is to provide a brief overview of our current understanding of the complex pathogenesis of RSV bronchiolitis and post-bronchiolitis wheeze. Two non-exclusive hypotheses exist, which are paraphrased for this review as "the chicken and the egg". First, we reviewed the pre-existent genetic, pulmonary and immunological mechanisms of RSV bronchiolitis and post-bronchiolitis wheeze. Second, RSV as the causative virus of long-term airway morbidity is reviewed. Clearly, RSV infection is capable of causing direct damage to the airways and/or inducing long-term inappropriate immune responses to respiratory viruses or aero-allergens. It is concluded that intervention trials aimed at preventing RSV infections are required to establish the relative contribution of both RSV-induced and pre-existent mechanisms to the development of long-term airway disease following RSV bronchiolitis.