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￣     

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.     

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。     

毛细支气管炎患儿细胞免疫功能与喘息发作的关系

毛细支气管炎是婴儿期常见的下呼吸道感染 ,相当一部分患儿随后出现反复喘息 ,部分转化为哮喘。本文通过观察呼吸道合胞病毒 (RSV)毛细支气管炎 (毛支 )患儿Th1/Th2细胞功能变化 ,探讨Th1/Th2细胞功能变化与喘息发作的关系。资料和方法一、临床资料　观察组 40例 ,男 2 4例 ,女 16例 ;年龄 40d～ 1岁 ,平均月龄 7.0± 2 .8个月。为 1999年 11月～ 2 0 0 0年 1月我院住院患儿。均符合 1987年卫生部小儿肺炎防治方案制定的毛支诊断标准[1] ,鼻咽部脱落细胞RSV抗原阳性 ,既往无过敏性疾病史及过敏性疾病家族史。对照组为健康婴儿 2 0例 ,男…     

呼吸道合胞病毒毛细支气管炎42例白三烯致病作用研究

目的研究呼吸道合胞病毒(RSV)毛细支气管炎患儿在急性期和恢复期鼻咽分泌物中白三烯的水平,探讨白三烯在RSV毛细支气管炎发病中的作用。方法选取2003年11月至2004年3月在北京儿童医院呼吸病房住院的42例RSV毛细支气管炎患儿作为RSV毛细支气管炎组;选取同期不伴喘息的呼吸道感染患儿21例作为对照组,对照组患儿RSV抗原检测均为阴性。收集患儿的临床资料并进行临床评分,于入院第1～7天取患儿的鼻咽分泌物(nasopharyngeal secretion,NPS),用ELISA方法做白三烯C4(leukotriene C4,LTC4)的检测,同时测定NPS的蛋白质含量,用LTC4与蛋白的比值进行校正。应用SPSS11.5统计软件对数据进行统计分析。结果RSV毛细支气管炎组NPS中LTC4的质量质量浓度为14.89pg/μg,蛋白(0.21～149.18),而同期对照组为2.10pg/μg,蛋白(0.33～13.06),RSV毛细支气管炎组明显高于对照组,差异具有统计学意义(P=0.006);对毛细支气管炎组患儿入院第1天和第7天的白三烯质量浓度进行比较,NPS中的LTC4(P=0.561)稍有下降,但差异无统计学意义。根据临床评分,轻度组和中度组白三烯的质量浓度差异无统计学意义。结论RSV感染毛细支气管炎患儿NPS中LTC4的质量浓度明显高于对照组。入院第7天于临床症状明显好转时再次检测LTC4的质量浓度,无显著性改变,仍是增高的。根据临床评分轻度组和中度组白三烯的质量浓度差异无统计学意义。     

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.     

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。     

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。     

Recurrent wheezing in children with respiratory syncytial virus (RSV) bronchiolitis in Qatar

Records of 70 infants admitted to Hamad General Hospital with RSV bronchiolitis and a similar number of controls were retrospectively reviewed. Two years after admission, 44% of the infants with RSV bronchiolitis developed recurrent wheezing compared with only 12.9% of controls (P=0.001). A family history of atopy appeared not to be a significant predisposing factor for the occurrence of recurrent wheezing in post RSV bronchiolitis patients. These results are similar to those from similar studies in industrialized countries.     

Long-term effects of respiratory syncytial virus (RSV) bronchiolitis in infants and young children: a quantitative review

One of the major questions regarding long-term side effects of bronchiolitis by respiratory syncytial virus (RSV) is whether or not it induces asthma in later life. In this quantitative review, the data of 10 controlled studies are analysed. METHODS: Follow-up studies of RSV bronchiolitis published between January 1978 and December 1998 were identified through a MEDLINE search. Studies were selected if (i) postnatal age at the time of the initial illness was below 12 mo, (ii) all children were hospitalized for RSV bronchiolitis, (iii) the diagnosis RSV was virologically confirmed in all cases, and (iv) a control group was used. RESULTS: Six studies met all selection criteria. Up to 5 y of follow-up after RSV bronchiolitis in infancy, 40% of children reported wheezing as compared to only 11% in the control group (p <0.001). Between 5 and 10 y of follow-up 22% of the bronchiolitis group reported wheezing against 10% of the control group (p = 0.19). The incidence of recurrent wheezing as defined by three or more wheezing episodes also decreased with increasing years of follow-up: at 5 or more years of follow-up the difference between the RSV group and the control group was no longer significant. Furthermore, the presence of either a personal and/or a family history of either atopy and/or asthma did not differ between the two groups. CONCLUSIONS: Wheezing is common after RSV bronchiolitis in infancy. It may persist for > or = 5 y of follow-up. However, no significant difference between the RSV bronchiolitis and the control group was observed regarding recurrent wheezing by 5 y of follow-up. No significant difference between the RSV bronchiolitis and the control group were found regarding a personal history of atopy, a family history of atopy and/or asthma. Therefore it seems unlikely that RSV bronchiolitis is a cause of atopic asthma in later life.     

The role of respiratory syncytial virus in acute bronchiolitis in small children in northern Japan

Respiratory syncytial virus (RSV) plays an important role in acute bronchiolitis, which is life threatening in some infants. We investigated the epidemiology of RSV acute bronchiolitis in children less than 3 years old in northern Japan. From April 1991 to March 1993, 162 infants with acute bronchiolitis were hospitalized in our pediatric wards. The diagnosis of RSV acute bronchiolitis was based on the typical clinical manifestations and the presence of RSV antigen in their nasopharyngeal specimens or the rise of the RSV antibody titer. 124 out of 162 patients (76.5%) were diagnosed as having RSV acute bronchiolitis. 43.5% of patients with RSV acute bronchiolitis were 6 months old or less. The epidemic of RSV acute bronchiolitis commenced in October, peaked in December and ended in summer. RSV is quite prevalent in infants with acute bronchiolitis in northern Japan.     

丙种球蛋白治疗RSV毛细支气管炎的临床及免疫学研究

为评估静脉注射丙种球蛋白(IVIG)治疗呼吸道合胞病毒毛细支气管炎(RSV毛支)的临床疗效及免疫学机理,比较26例IVIG治疗组和30例常规治疗组患儿症状体征消失时间及住院天数,同时检测治疗前后血清白介素6(IL-6)、白介素8(IL-8)及肿瘤坏死因子-α(TNF-α)水平。结果:与常规治疗组相比,IVIG治疗组喘憋和肺部体征消失时间明显缩短(4.0天±1.1天比5.2天±1.4天,5.4天±1.5天比6.5天±1.8天,P分别<0.001和<0.05),而住院天数则无显著差异(9.0天±2.2天比10.3天±3.1天,P>0.05)。治疗前两组患儿血清IL-6、IL-8及TNF-α水平均高于正常对照组;IVIG治疗后3种细胞因子水平明显降低.但与常规治疗组相比无显著差异。结论:细胞因子参与了RSV毛支的发病过程。IVIG治疗有较确切的临床疗效,但单剂(0.25g/kg)对血清细胞因子的抑制作用不明显。     

Viral bronchiolitis for the clinician

Viral bronchiolitis is common, and about 98–99% of infants are managed in the home. Because about 95% of infants <2 years old are infected with respiratory syncytial virus, however, bronchiolitis is the commonest reason for admission to hospital in the first 6 months of life. It is usually a self‐limiting condition lasting around a week in previously well children. About 1% of infants are admitted to hospital, and about 10% of hospitalised infants will require admission to the intensive care unit. Respiratory syncytial virus is isolated from about 70% of infants hospitalised with bronchiolitis. The emphasis of hospital treatment is to ensure adequate hydration and oxygenation. Other than supplemental oxygen, little in the way of pharmacological treatment has been demonstrated to alter the course of the illness or the risk of wheezing in the months following bronchiolitis.     

Association between pronounced IgA response in RSV bronchiolitis and development of allergic sensitization

Forty-five children who had heen hospitalized with bronchiolitis caused by respiratory syncytial virus (RSV) at a mean age of 4 months, and 90 matched control children, were tested for occurrence of RSV antibodies at one year of age. Of the children who had suffered from bronchiolitis. forty had demonstrable IgG antibodies, whereas the remaining five only had IgA antibodies against RSV. In the control group. 42% were RSV seropositive. The anti-RSV IgA antibody titres tended to be higher in patients with bronchiolitis ihan in controls and a larger proportion of the seropositive children in the former than in the latter group had demonstrable IgG antibodies. These fmdings suggest that RSV infections causing bronchiolitis are more often associated with a strong antibody response than are mild cases of the infection.
Follow-up of the children at 3 years of age showed that allergic sensitization and development of asthma had occurred much more frequently in children with past RSV bronchiolitis than in controls. Children with past RSV bronchiolitis who later developed allergic sensitization had elevated RSV IgA antibody titres at one year of age more frequently than children with past RSV-bronchiolitis. who were not sensitized (p=0.015). No significant differences regarding IgG antibody titres were observed. Since IgA, similarly a. s IgE. antibody formation is strongly Th2 cell dependent, the results are compatible with other fmdings suggesting that RSV has an unusual propensity to activate the Th2 cell system. This may contribute to the pathological picture of bronchiolitis in small children and at the same lime render the infected child predisposed for later development of allergic sensitization. RSV bronchiolitis may thus be an important risk factor for later development of atopic disease although it cannot be excluded that the bronchiolitis simply serves as a marker that predicts later development of atopy.     

Gender analysis in acute bronchiolitis due to respiratory syncytial virus

It is reasonable to compare immune reactions between boys and girls because many infections in the early stages are predominant in males. A relationship between immunomodulatory effects of sex hormone surge in boys at early months and infectious diseases is still unclear. We compared clinical features between boys and girls who suffered from wheezing that was initially triggered by acute respiratory syncytial virus (RSV) bronchiolitis. For systemic immune response evaluation, white blood cell (WBC) count, blood eosinophil count, and serum C-reactive protein (CRP) were measured. For local inflammation evaluation, scores for eosinophils and neutrophils in sputum were evaluated microscopically. Patients consisted of 90 boys and 51 girls. Most children were under 6 months of age. WBC counts and serum CRP levels were significantly increased in girls compared with boys. Blood eosinophilia at the acute stage was rarely observed in children after 6 months of age. For local response evaluation, sputum specimens obtained from 42 boys and 29 girls were microscopically examined. Sputum eosinophil score of 2+ and more was observed in boys (6/42) exclusively. In contrast, sputum neutrophilia was commonly observed in boys and girls. From a follow-up study, we confirmed that 28 children with RSV bronchiolitis showed wheezing episodes afterwards. However, their blood and sputum eosinophilia during RSV bronchiolitis did not reflect their subsequent wheezing. We speculated that gender-specific responses to RSV infection might account for male susceptibility. Differences in RSV pathogenicity between boys and girls should be further investigated in terms of asthma progression.     

氨溴特罗佐治婴幼儿毛细支气管炎疗效分析

目的观察氨溴特罗(氨溴索及克伦特罗的复合制剂)治疗毛细支气管炎的临床疗效。方法将96例毛细支气管炎患儿随机分为治疗组48例,对照组48例。两组均采用抗感染、止咳、化痰、雾化、吸痰等常规治疗。治疗组加用氨溴特罗口服液口服,观察比较两组疗效。结果治疗组在喘憋消失、咳嗽消失天数及哮鸣音和湿罗音消失天数、住院天数等均较对照组明显缩短(P均0.01),治疗组总有效率高于对照组,两组不良反应发生率差异无统计学意义。结论氨溴特罗治疗毛细支气管炎疗效显著、安全。     

长期吸入糖皮质激素对支气管哮喘患儿身高的影响

支气管哮喘(哮喘)是儿童期最常见的慢性疾病,吸入糖皮质激素(ICS)仍是目前哮喘治疗中最有效的方法。但由于本身存在的不良反应,使其在临床应用中受到一定的影响。通过对近年国内外相关文献进行综述,认为短期吸入中小剂量糖皮质激素(GC)对哮喘儿童的身高无显著性影响。对长期吸入者身高的影响与ICS的种类、剂量、疗程、吸入器、吸入技术、不同年龄以及个体对激素的敏感程度等有关,可采取一定的措施预防ICS对身高的影响。