婴幼儿支原体肺炎后反复发作性呼吸道感染因素分析

目的探讨婴幼儿支原体肺炎感染后反复呼吸道感染的影响因素分析。方法选取2013年6月~2013年12月我院儿科收治的150例支原体肺炎患儿作为研究对象,跟踪患儿治愈出院前后的MP-Ig M、MP-Ig G双抗体滴度及免疫功能,并记录呼吸道感染情况及一年内的用药情况。采用统计学方法进行多因素分析。结果 150例支原体肺炎患儿中,发生RRTI 45例,发生率为30.0%。多因素结果显示,年龄为3~6岁(OR=2.31,95%CI:1.23~4.68)、HP抗体阳性或转阳(OR=4.51,95%CI:1.56~13.27)、CD_4~+/CD_8~+下降(OR=10.33,95%CI:3.45~32.02)及Ig A下降(OR=1.96,95%CI:1.12~3.47)是诱发RRTI的危险因素;使用免疫增强剂(OR=0.31,95%CI:0.14~0.82)是有效预防反复呼吸道感染的保护因素。结论年龄3~6岁、HP抗体阳性或转阳、CD_4~+/CD_8~+下降及Ig A下降是RRTI发生的危险因素;MP肺炎治愈后发生免疫功能障碍的患儿易发生RRTIs;免疫增强剂的使用可有效减少RRTI的发生,提高患儿的生活质量。     

儿童肺炎支原体肺炎治愈1年内发生反复呼吸道感染的相关因素研究

目的探究儿童肺炎支原体肺炎(mycoplasma pneumoniae pneumonia,MPP)患者治愈1年内发生反复呼吸道感染(recurrent respiratory tract infections,RRTI)的相关因素。方法对2017年3月—2018年3月间于我院治愈的78例MPP患儿定期随访1年,记录随访期间RRTI发生情况。根据是否发生RRTI,将其分为未发生组(n=47)和发生组(n=31)。统计2组患儿的一般资料并进行单因素分析,对有统计学意义的指标进行多因素Logistic回归分析。结果78例MPP患儿随访1年期间,共有31例发生RRTI,发生率为39.74%。多因素Logistic回归分析显示:年龄3~6岁、肺炎支原体(Mycoplasma pneumoniae,MP)抗体阴转阳、MP抗体阳性、未使用免疫增强剂、CD4^+/CD8^+比值降低、IgA低于正常水平均为MPP患儿治愈1年内发生RRTI的独立危险因素(OR=2.551,5.709,3.017,2.325,3.024,2.486,P均<0.05)。结论年龄3~6岁、MP抗体阴转阳、MP抗体阳性、未使用免疫增强剂、CD4^+/CD8^+比值降低、IgA低于正常水平均为MP感染治愈1年内发生RRTI的独立危险因素。临床上应合理使用抗生素及糖皮质激素,积极治疗免疫功能低下患儿,加强对病情的监测及随访,改善患儿预后。     

也门儿童的人麦塔肺病毒和呼吸道合胞病毒

发展中国家中能够增加呼吸道感染严重性的因素很少被关注。我们报道的因素与发生在也门儿童的严重的呼吸系统疾病有关（266位呼吸合胞病毒感染和66位人麦塔肺病毒感染）．年龄．室内空气污染和不完全接种疫苗是危险因素．这不同于发达国家．     

小儿呼吸道衣原体感染与喘息性疾病的关系

衣原体是一类有独特发育周期，严格细胞内寄生的原核细胞型微生物，大致分为4类：沙眼衣原体(chlamydia trachomatis，CTr)、肺炎衣原体(chlamydia pneumoniae，CPn)、鹦鹉热衣原体(chlamydia psittaci，CPs)、牲畜衣原体(chlamydia pecorum，CPe)，前两是引起小儿呼吸系统感染的常见病原体。自从确定衣原体为人类致病菌以来，     

呼吸道合胞病毒感染的免疫防治进展

呼吸道合胞病毒（ＲＳＶ）有Ａ、Ｂ两个抗原型，Ｆ和Ｇ糖蛋白是是主要的性抗原。自然感染ＲＳＶ后不能获得持久的免疫保护，于流行季节注射特异性免疫球蛋白（ＲＳＶＩＧ）可预防高危婴幼儿感染ＲＳＶ，并减轻感染疾病程度，有效率约６５－８５％，但治疗价值尚需作进一步评价。ＲＳＶ重组亚单位疫苗虽安全性强，但性有提高，减毒活疫苗如Ｃｐｔｓ－２４８／４０４突变株等，有望成为较理想的候选疫苗。     

成人呼吸道合胞病毒的电镜和免疫电镜研究

本研究主要探讨呼吸道合胞病毒（ＲＳＶ）成人感染的电镜诊断。应用常规电镜和金标记电镜技术观察９７例ＲＳＶ阳性患者鼻咽部脱落细胞。一些标本的脱落上皮细胞表面在常规电镜下查见ＲＳＶ形态特征的病毒颗粒，免疫电镜可见金颗粒特异性标记。提示，ＲＳＶ是成人呼吸道感染的病原之一。     

成人呼吸道合胞病毒下呼吸道感染临床特征和预后分析

目的 分析成人呼吸道合胞病毒(RSV)下呼吸道感染患者的临床特征及预后.方法 以2016年8月至2019年11月入住中日友好医院呼吸科或重症监护病房(ICU)的RSV核酸阳性患者148例为研究对象,同时取甲型流感病毒(FluA)核酸阳性的下呼吸道感染患者266例为对照组,根据是否合并免疫功能低下,分为免疫功能正常组和免...     

肺炎支原体与成人呼吸道感染关系的初步探讨

本文探讨肺炎支原体(MP)与成人呼吸道感染的关系。提示肺炎支原体是成人呼吸道感染的重要病原体之一,可能也是慢性阻塞性肺病的病因或急性发作的原因之一。     

2009-2016年广州市呼吸道合胞病毒感染的流行特征及临床特点分析北大核心CSCD

目的分析急性上呼吸道感染患者中呼吸道合胞病毒(respiratory syncytial virus,RSV)的流行特征及临床特点。方法以南方医科大学珠江医院2009年11月至2016年6月收治的具有发热呼吸道症状患者为研究对象,采集鼻拭子标本3446份,提取标本RNA,采用qRT-PCR方法进行RSV检测,并对RSV阳性标本进行临床上常见的7种(14个亚型)呼吸道病毒的检测,以了解混合感染情况。结果共检测患者标本3446份,其中RSV阳性标本672份,总阳性率为19.5%。4个季节中RSV检出率差异具有统计学意义(χ2=133.184,P<0.001),并以春节最高,冬季次之,夏秋两季最少。RSV感染患者随着年龄的增长检出率逐渐降低,并以3岁及以下儿童检出率最高,占RSV阳性标本数的90.8%(610/672),儿童患者检出率明显高于成年患者(χ2=266.433,P<0.001),男性患者检出率明显高于女性患者(χ2=4.940,P=0.026),住院患者检出率明显高于门诊患者(χ2=60.433,P<0.001)。混合感染标本160份,其中双病毒感染标本143份,3种病毒混合感染16份,4种病毒混合感染1份,并以鼻病毒和呼吸道合胞病毒混合感染率最高,住院患者混合感染率高于门诊患者(χ2=20.896,P<0.001)。与非RSV感染者相比,RSV感染者咳嗽、咳痰、气促/呼吸困难等临床症状发生率均较高(χ2_(咳嗽)=108.934,χ2_(咳痰)=60.626,χ2_(气促/呼吸困难)=38.139,均P<0.001),而咽喉痛、头痛、乏力、寒战/畏寒和肌肉酸痛等发生率相对较低(χ2_(咽喉痛)=46.499,χ2_(头痛)=29.516,χ2_(乏力)=16.972,χ2_(寒战/畏寒)=9.616,χ2_(肌肉酸痛)=8.801,均P<0.001)。此外,RSV感染组与非RSV感染组在临床诊断上也存在统计学差异(χ2=212.157,P<0.001)。结论RSV是引起3岁以下儿童呼吸道病毒感染的主要病原体,也是引起3岁以下儿童呼吸道病毒感染住院的主要原因,咳嗽、咳痰及气促/呼吸困难的发生率较高,临床上应加强对该年龄段儿童的防护。     

呼吸道合胞病毒感染的研究进展

呼吸道合胞病毒（RSV）归属于副粘病毒科、肺炎病毒属。RSV感染是小儿最常见的下呼吸道感染性疾病，在临床上主要引起毛细支气管炎，往往导致严重的喘弊症状、本文对有关RSV感染的发病机理、诊断方法及治疗作一综述。RSV感染的发病机理以往的研究表明．RSV病毒复制引起的细胞病     

Absence of human metapneumovirus co-infection in cases of severe respiratory syncytial virus infection

It has been suggested that co-infection of human metapneumovirus (hMPV) in severe respiratory syncytial (RSV) virus bronchiolitis is very common. To evaluate the epidemiology of hMPV co-infection in children with severe lower respiratory tract infection caused by RSV virus. This was an observational cohort study in which hMPV and RSV viral load was measured by RT-PCR in tracheal specimens from the target population. hMPV could not be detected in any of the 30 mechanically ventilated children with RSV lower respiratory tract infection. Our study suggests that hMPV co-infection is not very common in severe RSV lower respiratory tract infection.     

焦作地区0-6岁学龄前儿童急性上呼吸道感染病原体分析

目的通过对儿童上呼吸道病原体感染情况分析,了解病原学分布情况,为临床诊疗提供依据。方法将956例急性上呼吸道感染的0-6岁学前幼儿分为三组,A组30天-1岁,B组1-3岁,C组3-6岁,进行病原体血清学检测,对不同年龄段发病情况进行对比。按照季节分布情况对不同季节感染类型进行分析。结果发病人数比例年龄组1-3岁48.01%(459/956),3-6岁组32.22%(308/956),30天-1岁组19.77%(189/956);病原体检测阳性率情况1-3岁年龄组阳性率72.11%,3-6岁组51.30%,30天-1岁组46.03%。四季阳性率分别为29.57%,20.59%,74.75%,77.69%。结论 1-3岁年龄组发病率,阳性率最高。秋冬两季检出率均明显高于夏春两季。     

Pulmonary function sequelae after respiratory syncytial virus lower respiratory tract infection in children: A systematic review

Respiratory syncytial virus (RSV) lower respiratory tract infection (LRTI) during early childhood may be associated with subsequent pulmonary sequelae, including recurrent wheezing and asthma. We undertook a systematic review to investigate the pulmonary function sequelae following RSV LRTI in the first 3 years of life. The systematic review protocol was registered on PROSPERO (CRD42018087168). PubMed, Scopus, Cochrane Library, and World Health Organization Global Index Medicus, as well as ClinicalTrials.gov and Cochrane Central Register of Controlled Trials, were searched up until 15 June 2019 for published and unpublished interventional and observational studies with the end‐point outcome of pulmonary function testing (PFT) after a proven RSV LRTI in the first 3 years of life. Two independent reviewers screened all the titles, abstracts and full texts. Data were extracted using a standardized data extraction form. Corresponding authors were contacted for additional information if required. All studies were assessed for risk of bias using the Newcastle‐Ottawa quality assessment scale. The final analysis included 31 studies. Thirteen studies using spirometry reported no association between RSV LRTI and pulmonary function sequelae. The remaining 16 reported abnormal spirometry; 12 obstructive airways disease, three restrictive lung disease, and one mixed lung disease. The heterogeneity in PFT techniques, different ages at testing, and methods used for reporting outcomes made direct comparisons or pooled effect estimates impossible. Children with confirmed RSV LRTI during the first 3 years of life often have abnormal PFTs, favoring obstructive airways disease. The evidence, however, is not overwhelming with conflicting results between studies.     

Eosinophil cationic protein in infants with respiratory syncytial virus bronchiolitis: predictive value for subsequent development of persistent wheezing

Infants with acute bronchiolitis during the first months of life are at increased risk of developing persistent wheezing and bronchial asthma later in life. The study of eosinophil cationic protein (ECP) suggests that eosinophil-related inflammatory mechanisms may play a role in respiratory syncytial virus (RSV) bronchiolitis. The aim of our study was to verify whether serum ECP (s-ECP) measurements are useful in predicting the development of persistent wheezing in children affected by RSV bronchiolitis during a 5 years follow-up period. Forty-eight infants were enrolled prospectively (mean age: 153.5 days). All had a clinical and radiological diagnosis of acute bronchiolitis and confirmed RSV infection. Peripheral eosinophil counts, levels of s-ECP, and serum IgE concentrations were measured during bronchiolitis. Five years later the children were re-evaluated in regard to their respiratory symptoms (standardized questionnaires) and atopic status (specific IgE levels). We observed significantly higher s-ECP levels (P < 0.001) at enrollment in subjects who developed persistent wheezing compared to subjects who did not show late wheezing. Initial s-ECP values allowed significant and correct prediction of persistent wheezing (P < 0.001). The risk to develop respiratory symptoms was 9.73 higher for infants with s-ECP levels > or = 8 microg/L than for those with s-ECP levels <8 microg/L (P < 0.0001). In conclusion, our study suggests that s-ECP levels in infants with bronchiolitis are useful in predicting the risk to develop wheezing in the subsequent 5 years.     

Epidemiological and clinical data of hospitalizations associated with respiratory syncytial virus infection in children under 5 years of age in Spain: FIVE multicenter study

Background

Respiratory syncytial virus (RSV) is an important pathogen in lower respiratory tract infections (LRTI) in infants, but there are limited data concerning patients with underlying conditions and children older than 2 years of age.

Methods

We have designed a prospective observational multicenter national study performed in 26 Spanish hospitals (December 2011–March 2012). Investigational cases were defined as children with underlying chronic diseases and were compared with a group of previously healthy children (proportion 1:2). Clinical data were compared between the groups.

Results

A total of 1763 children hospitalized due to RSV infection during the inclusion period were analyzed. Of them, 225 cases and 460 healthy children were enrolled in the study. Underlying diseases observed were respiratory (64%), cardiovascular (25%), and neurologic (12%), as well as chromosomal abnormalities (7·5%), immunodeficiencies (6·7%), and inborn errors of metabolism (3·5%). Cases were statistically older than previously healthy children (average age: 16·3 versus 5·5 months). Cases experienced hypoxemia more frequently (P < 0·001), but patients with respiratory diseases required oxygen therapy more often (OR: 2·99; 95% CI: 1·03–8·65). Mechanical ventilation was used more in patients with cardiac diseases (OR: 3·0; 95% CI: 1·07–8·44) and in those with inborn errors of metabolism (OR: 12·27; 95% CI: 2·11–71·47). This subgroup showed a higher risk of admission to the PICU (OR: 6·7, 95% CI: 1·18–38·04). Diagnosis of pneumonia was more frequently found in cases (18·2% versus 9·3%; P < 0·01).

Conclusions

A significant percentage of children with RSV infection have underlying diseases and the illness severity is higher than in healthy children.