Chemerin在婴幼儿呼吸道合胞病毒肺炎中的调节作用

目的探讨趋化蛋白chemerin在呼吸道合胞病毒(RSV)肺炎中的临床意义。方法入选RSV肺炎患儿82例,其中轻症65例,重症17例;对照组儿童40例。ELISA法检测并比较各组血清chemerin、肿瘤坏死因子(TNF-α)、细胞因子(IL-17)、IL-10及转化生长因子(TGF-β)水平。结果 RSV肺炎轻症组、重症组和对照组的血清chemerin水平分别为(539.98±65.86)pg/ml、(786.62±82.59)pg/ml和(337.24±43.37)pg/ml,差异有统计学意义(F=150.29,P=0.000);重症组血清chemerin水平分别高于轻症组和对照组,轻症组高于对照组,差异有统计学意义(P均0.05)。三组间TNF-α、IL-17、IL-10和TGF-β水平的差异均有统计学意义(F=46.80~284.36,P均0.05)。RSV肺炎患儿的血清chemerin水平与TNF-α、IL-17水平均呈显著正相关(r=0.81、0.61,P均0.05),而与IL-10、TGF-β则呈显著负相关(r=–0.80、–0.75,P均0.05)。结论 RSV肺炎患儿血清chemerin水平升高,与炎症程度相关,并与促炎细胞因子水平正相关;chemerin可能在RSV感染中发挥重要的调节作用。     

细胞因子与呼吸道合胞病毒感染

呼吸道合肥病毒是引起婴幼儿毛细支气管炎和肺炎的最常见病原体，越来越多的研究表明，ＲＳＶ感染的发病机制与机体异常的免疫病理有关。ＲＳＶ感染后细胞因子的变化；如：ＩＬ－１抑制物的产生，ＩＬ－２活性降低，ＩＬ－２Ｒ表达障碍。ＩＦＮγ减少和ＩＬ－４，ＩＬ－５，ＩＬ－６，ＩＬ－８，ＴＮＦα的活性弱强，在ＲＳＶ感染的免疫保护和免疫病理中起重要作用。     

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...     

小儿呼吸道合胞病毒感染

呼吸道合胞病毒是婴幼儿呼吸道感染最常见的病原体。近年研究发现，其发病机制包括病毒与宿主受累细胞损伤、炎症、体液和局部免疫反应及高反应性之间的相互作用。呼吸道分泌物荧光素标记抗体检测快速，敏感性和特异性高。三氮唑核苷、免疫球蛋白及干扰素常能达到早期病因治疗，通过气雾吸入等局部给药途径，使疗效明显提高。尚在试制的呼吸道合胞病毒新型疫苗及基因治疗研究为该病的防治提供了良好的前景。     

细胞因子与呼吸道合胞病毒感染

呼吸道合胞病毒（ＲＳＶ）是引起婴幼儿毛细支气管炎和肺炎的最常见病原体，越来越多的研究表明ＲＳＶ感染的发病机制与机体异常的免疫病理有关。ＲＳＶ感染后细胞因子的变化，如：ＩＬ－１抑制物的产生，ＩＬ－２活性降低，ＩＬ－２Ｒ表达障碍，ＩＦＮγ减少和ＩＬ－４、ＩＬ－５、ＩＬ－６、ＩＬ－８、ＴＮＦα的活性增强，在ＲＳＶ感染的免疫保护和免疫病理中起重要作用。     

呼吸道合胞病毒致婴儿下呼吸道感染时细胞免疫观察

共测定52例RSV下呼吸道感染患婴在急性期和恢复期中IL-2水平、NK活性及T细胞亚群。结果显示IL-2水平,NK活性及CD4/CD8均明显降低,恢复期则基本恢复正常。毛细支气管炎组恢复期的CD8明显低于肺炎组恢复期的CD8。说明RSV下呼吸道感染患儿存在明显的细胞免疫异常,可能是其在感染RSV后易发展成严重感染的原因之一,而且与以后哮喘的发生有一定关系。     

重症呼吸道合胞病毒肺炎82例临床特点分析

目的:调查重症呼吸道合胞病毒(RSV)肺炎患儿临床特点,为临床尽早识别RSV感染重症病例提供依据。方法:分析2019年1月至2020年5月收入我院PICU的重症RSV肺炎患儿的临床资料,分析临床特点。结果:共收集重症RSV肺炎82例。(1)RSV感染高峰出现在1月至3月;(2)收入PICU的重症RSV肺炎患儿年龄以<3...     

婴幼儿喘息与呼吸道合胞病毒肺炎支原体感染及过敏的关系

目的了解婴幼儿喘息性疾病与呼吸道合胞病毒、肺炎支原体感染的关系,同时进行常见食物过敏原和吸入过敏原筛查,旨在探讨婴幼儿喘息与呼吸道合胞病毒、肺炎支原体感染及过敏的关系及其与支气管哮喘的相关性。方法对2000-01—2003-12在南京中医药大学附属医院就诊的232例下呼吸道感染的婴幼儿进行呼吸道合胞病毒、肺炎支原体抗体的检测,并进行过敏原检测,收集特异性体质的表现及家族史,对有喘息症状的部分患儿进行随访。结果喘息组患儿以上2种病原体感染率高于非喘息组;81例喘息患儿随访中,有67.90%(55例)的患儿转为哮喘,这部分患儿的特应性体质表现及家族史与发病密切相关。结论婴幼儿喘息性疾病与呼吸道合胞病毒、肺炎支原体感染密切相关,过敏是婴幼儿反复发生喘息性疾病的重要危险因素。     

静注免疫球蛋白治疗呼吸道合胞病毒感染与病毒消除效应

本文使用ＩＶＩＧ０．４～０．５ｇ／ｋｇ．ｄ共２天治疗２３例ＲＳＶ毛细支气管炎患儿，与对照组３２例比较，发现应用ＩＶＩＧ后３～５天血清ＩｇＧ水平升高１．９１倍ＲＳＶ－ＳＩｇＧ升高３．２２倍，呼吸道ＲＳＶ抗原６８小时内阴转，临床症状体征较快恢复正常，本批ＩＶＩＧ制品中ＲＳＶ－ＳＩｇＧ水平（１：６４０）远远高于用药前ＲＳＶ感染患儿平均水平（１：１１６）提示ＩＶＩＧ能迅速提高血清ＩｇＧ水平，补充大量ＲＳＶ     

Sharing features of uncommon respiratory syncytial virus complications in infants

We describe 4 nonconsecutive cases of infants admitted to Catholic University pediatric intensive care unit (PICU) because of complicated respiratory syncytial virus (RSV) infection during winter RSV outbreaks from the year 2000 to the year 2003. A hyponatremic epileptic status (as in the first case) has been reported by several authors as a rare RSV complication, potentially leading to death. The second infant developed a serious pulmonary edema after a subglottic obstruction (croup) associated with RSV infection. The remaining 2 infants developed a pneumothorax and subcutaneous emphysema while breathing spontaneously during an RSV bronchiolitis. In all infants, a full recovery and PICU discharge was achieved despite the need for mechanical ventilation in cases 1 and 2. Increased intrapleural negative pressure or its combination with hypoxia/hypercapnia has been suggested as the common factor possibly joining these different clinical pictures.     

Palivizumab prophylaxis of respiratory syncytial virus infection in high-risk infants

Palivizumab prophylaxis significantly reduces hospitalization for respiratory syncytial virus (RSV) disease in preterm infants. However, palivizumab is very expensive. Data from a New Zealand cost-effectiveness analysis were considered by representatives of the Infectious Diseases and Immunisation, Fetus and Newborn, and Respiratory Committees of the Paediatric Society of New Zealand. Prophylaxis in all high-risk groups was associated with net cost. The consensus panel recommends that the priority for palivizumab be given to babies discharged on home oxygen with chronic lung disease, followed by babies born at 28 weeks or less gestation.     

Duration of hospitalization in previously well infants with respiratory syncytial virus infection

To describe the typical hospital course of infection in previously well infants hospitalized with respiratory syncytial virus (RSV) infection, we reviewed the charts of 196 patients with laboratory-proved respiratory syncytial virus infection in the 1987-1988 respiratory disease season. Eighty-seven of the children had been previously well. Their mean duration of hospitalization was 3.4 days. Previously well infants younger than 6 weeks of age experienced significantly longer hospitalizations and more days of supplemental oxygen and were more likely to require intensive care than were older children. Children older than 12 weeks of age were hospitalized for a mean of 2.5 days and did not require intensive care. Oxygen saturation was measured in the emergency room for 67 of the previously well infants; in 42 oxygen saturation was at least 90% whereas in 25 saturation was less than 90% or infants were receiving supplemental oxygen at the time of measurement. Decreased initial oxygen saturation was associated with a prolonged hospitalization (5.3 vs. 3.2 days, P less than 0.01) and with more days of supplemental oxygen (4.4 vs. 1.5 days, P less than 0.01). We conclude that among previously well infants admitted to the hospital with respiratory syncytial virus infection, infants younger than 6 weeks of age are at increased risk for a prolonged and more severe hospital course than are older children.     

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     

新生儿和婴儿呼吸道合胞病毒致急性下呼吸道感染临床特征和疾病负担

目的了解上海地区新生儿和婴儿呼吸道合胞病毒（RSV）感染的严重程度及疾病负担,为RSV感染的监测及临床防治提供科学依据。方法回顾性收集2012年3月至2013年2月复旦大学附属儿科医院内科和新生儿科住院并确诊为急性下呼吸道感染（ALRI）≤1岁患儿的病历,截取人口学资料、临床特征、病死率、并发症、住院时间和费用等指标,并采用严重度指数(SI)进行RSV感染严重程度综合评价。分为新生儿组和婴儿组,并进一步分为单一感染和混合感染亚组进行分析。 结果1 726例ALRI≤1岁患儿中RSV阳性913例（52.9%）进入分析。新生儿组295例,婴儿组618例。①SI评分新生儿组高于婴儿组,(2.5±0.2) vs (1.9±0.1)分,P<0.05;较重度和重度比例新生儿组显著高于婴儿组,但单一感染和混合感染亚组间差异无统计学意义。②RSV感染的≤1岁患儿病死率为5.0％,新生儿组病死率与婴儿组差异无统计学意义,婴儿组合并基础疾病患儿病死率高。③机械通气比例两组间差异无统计学意义,婴儿组混合感染亚组高于单一感染亚组。④并发症情况：新生儿组呼吸暂停和脓毒症发生率较高,新生儿组混合感染亚组脓毒症发生率显著高于单一感染亚组。⑤住院天数新生儿组与婴儿组差异无统计学意义,合并基础疾病者显著高于未合并疾病疾病患儿;住院费用婴儿组显著高于新生儿组,新生儿混合感染亚组显著高于单一感染亚组,合并基础疾病患儿显著高于未合并基础疾病患儿。 结论RSV感染新生儿的重症比例和并发症的发生率较高,婴儿组住院费用较高。混合感染和合并基础疾病是影响RSV感染严重程度和疾病负担的重要因素。