毛细支气管炎的诊治进展

毛细支气管炎是婴幼儿较常见的一种下呼吸道感染性疾病,临床卜以下呼吸道梗阻所敛的喘憋为特征[1].现对毛细支气管炎的病原、机制、治疗综述如下. 1 毛细支气管炎的流行病学及病因学 呼吸道合胞病毒(RSV)是引起毛细支气管炎最常见的病原体,占70%以上,其外壳中F和G精蛋白是形成RSV中和抗体的惟一成分,是疫苗研究的主要目标.RSV分为A、B两种亚型,流行季节可同时传播,但有报告显示RSV-A型较B型感染可引起更严重疾病.     

鼻病毒感染致毛细支气管炎的研究进展

鼻病毒(rhinovirus,RV)是最常见的呼吸道病毒,可以引起上、下呼吸道感染性疾病,如普通感冒、毛细支气管炎等。其中毛细支气管炎是引起2岁以下婴幼儿喘息发作的主要病因,患病率逐年增加,早期研究认为主要病原学是呼吸道合胞病毒(respiratory syncytial virus,RSV),但近年来发现越来越多的毛...     

毛细支气管炎与哮喘的关系

毛细支气管炎是引起2岁以下婴幼儿喘息发作的主要病因,多由病毒感染引起,其中呼吸道合胞病毒（RSV）和鼻病毒（RV）是最常见的病原体。近年来,研究发现生后早期RSV和RV感染诱发的毛细支气管可能与患儿日后反复喘息发作甚至发展为哮喘密切相关。该文拟对RSV和RV感染后诱发的毛细支气管炎与日后反复喘息发作及发展为哮喘的关系、病毒感染后对肺功能的长期影响、发展为哮喘可能的发病机制和危险因素及预防策略等方面问题进行介绍。     

婴幼儿毛细支气管炎护理体会

毛细支气管炎是2岁以下婴幼儿较常见的一种呼吸道感染疾病，多发生于6个月以内的婴儿。尤以2—4个月居多。引起毛细支气管炎最常见的病毒是呼吸道合胞病毒，其次为流感病毒、副流感病毒和腺病毒。常见致病菌有肺炎球菌、链球菌、葡萄球菌、流感杆菌等。该病发病急，临床表现为呼吸困     

呼吸道合胞病毒感染防治进展

呼吸道合胞病毒(RSV)是引起婴幼儿毛细支气管炎、肺炎的重要病原.RSV感染引起的毛细支气管炎诊断并不困难,但关于感染后喘息、发生哮喘的机制并不明确.目前尚没有防治RSV感染的疫苗与特效药.随着对RSV感染预防控制及治疗方法的深入研究,为临床面对RSV挑战提供了新思路与前景.     

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呼吸道合胞病毒(RSV)是引起婴幼儿下呼吸道感染最主要病毒病原,全球每年约有16万例婴幼儿死于RSV相关的下呼吸道感染,约10%的RSV毛细支气管炎和(或)肺炎需要住院治疗[1],医疗花费巨大,RSV感染后出现的反复喘     

呼吸道病毒感染对婴幼儿鼻咽部嗜酸性粒细胞的影响

目的分析婴幼儿呼吸道合胞病毒(RSV)感染与鼻咽分泌物嗜酸性粒细胞的关系,探讨呼吸道病毒感染对过敏及喘息发生的影响。 方法选择2002—2004在首都儿科研究所就诊的呼吸道疾病婴幼儿223例,包括肺炎组82例,毛细支气管炎组65例,反复喘息组76例。取患儿鼻咽分泌物,分离培养RSV等7种较常见病毒,并检测嗜酸性粒细胞,进行对比分析。 结果3组间病毒检测阳性率不同(P<0.05),RSV检测阳性率差异存在显著性意义(P<0.01);3组患儿鼻咽分泌物嗜酸性粒细胞计数不同(P=0.000),反复喘息组高于毛细支气管组及肺炎组(均P<0.01)。 结论RSV是婴幼儿毛细支气管炎、反复喘息和肺炎的主要病原。RSV等病毒感染并不促使过敏的发生。     

婴儿毛细支气管炎鼻病毒感染的临床特征

目的 了解婴儿毛细支气管炎的病原分布,鼻病毒(RV)感染状况及RV感染所致婴儿毛细支气管炎的临床特征.方法 选择毛细支气管炎患儿187例.采用半巢式PCR法检测患儿鼻咽分泌物RV RNA;采用免疫荧光方法测定流感病毒A、流感病毒B、呼吸道合胞病毒(RSV)、腺病毒,及副流感病毒1、2、3型感染情况.结果 187例毛细支气管炎患儿中,RV感染占31.55%,RSV感染占22.46%.RV感染患儿与RSV感染患儿性别、月龄、起病天数和Lowell评分比较差异均无统计学意义(Pa>0.05),缓解天数比较差异有统计学意义(P=0.050),RV感染患儿较RSV感染患儿临床症状缓解快.结论 RV是引起婴儿毛细支气管炎的最常见病原体,RV感染患儿较RSV感染患儿缓解迅速.半巢式PCR方法检测患儿鼻咽分泌物鼻病毒RNA具有很高的敏感性、特异性.     

呼吸道合胞病毒感染发病机制

呼吸道合胞病毒（RSV）是引起婴幼儿下呼吸道感染的主要病原。婴幼儿感染RSV后可发生严重的毛细支气管炎（简称毛支）和肺炎,与儿童哮喘有一定的关联。研究RSV感染的发病机制,有助于深入认识毛支的发生、发展及预后,尤其是早期喘息与哮喘的关系。现就最近有关RSV感染的免疫学和神经免疫机制的研究进展作一综述。     

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毛细支气管炎是婴幼儿时期常见的一种下呼吸道感染性疾病,流行面广,发病率高,仅见于2岁以下的婴幼儿,多数为6个月以内的小婴儿。其发病与该年龄小儿的支气管解剖学特点有关[1]。该年龄组小婴儿支气管和肺处于生长发育的薄弱时期,感染后,细小的管腔易因炎症分泌物、水肿和肌收缩而发生梗阻,并引致肺气肿和肺不张。其临床症状如肺炎,但喘憋更为突出。临床上较难发现未累及肺泡与肺泡间壁的单纯的毛细支气管炎,故国外认为是一种特殊型的肺炎,也有人称之为喘憋性肺炎[1]。毛细支气管炎主要由病毒引起。本文谈谈其病因学及相关治疗。1毛细支气管…     

Bronchiolitis-associated hospitalizations among American Indian and Alaska Native children

BACKGROUND: Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract illness among infants and young children. Respiratory system diseases account for a large proportion of hospitalizations in American Indian and Alaska Native (AI/AN) children; however, aggregate estimates of RSV-associated hospitalizations among AI/AN children have not been made. METHODS: We used Indian Health Service hospitalization data from 1990 through 1995 to describe hospitalizations associated with bronchiolitis, the most characteristic clinical manifestation of RSV infection, among AI/AN children <5 years old. RESULTS: The overall bronchiolitis-associated hospitalization rate among AI/AN infants < 1 year old was considerably higher (61.8 per 1,000) than the 1995 estimated bronchiolitis hospitalization rate among all US infants (34.2 per 1,000). Hospitalization rates were higher among male infants (72.2 per 1,000) than among females infants (51.1 per 1,000). The highest infant hospitalization rate was noted in the Navajo Area (96.3 per 1,000). Hospitalizations peaked annually in January or February, consistent with national peaks for RSV detection. Bronchiolitis hospitalizations accounted for an increasing proportion of hospitalizations for lower respiratory tract illnesses. CONCLUSIONS: Bronchiolitis-associated hospitalization rates are substantially greater for AI/AN infants than those for all US infants. This difference may reflect an increased likelihood of severe RSV-associated disease or a decreased threshold for hospitalization among AI/AN infants with bronchiolitis compared with all US infants. AI/AN children would receive considerable benefit from lower respiratory tract illness prevention programs, including an RSV vaccine, if and when one becomes available.     

Bronchiolitis: in-patient focus

Bronchiolitis is among the most common and serious lower respiratory tract syndromes that affects young children. In developed countries, the case fatality rate among previously healthy children remains low; in contrast, infants with underlying medical conditions, such as immunodeficiency or chronic lung disease, are at risk of prolonged illness and death. Bronchiolitis is associated with significant morbidity among healthy young children. During the winter season, bronchiolitis is the most common cause of hospitalization among infants. Each year in the United States, approximately 2 per 100,000 infants die as a result of complications associated with bronchiolitis.     

毛细支气管炎治疗新观点

毛细支气管炎是婴幼儿较常见的下呼吸道感染,多由呼吸道合胞病毒引起。目前的治疗主要为包括氧疗、控制喘息、维持内环境稳定等的综合治疗。多数毛细支气管炎尚缺乏特异性的病原治疗药物。探讨毛细支气管炎治疗新方法有助于改善患儿症状、缩短住院日,改善中重度毛细支气管炎患儿、尤其是＜6月龄且有高危因素的患儿预后。     

Bronchiolitis in infants

Bronchiolitis is a common cause of wheezing among infants. Respiratory syncytial virus (RSV) is the most common infectious agent to cause bronchiolitis, and RSV infection accounts for more than 125,000 hospitalizations per year in the United States. Beyond supportive measures, the care of infants with bronchiolitis remains controversial. Practitioners continue to treat infants with a variety of pharmacologic agents, despite limited evidence of their efficacy. Investigators continue to search for the safest and most cost-effective methods to treat infants with bronchiolitis, not only to overcome obstructive symptoms during the acute illness, but also to prevent recurrent symptoms of airway obstruction that occur in some children for years after their initial episode of bronchiolitis. Improved understanding of the pathogenesis of RSV infection and of virus-host interactions may one day lead to the development of agents that alter the initial inflammatory response and strategies that help prevent recurrent episodes of wheezing and the development of asthma after acute bronchiolitis.     

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??Objective To determine the relationship between clinical features of bronchiolitis in children under 2 years old and lymphocyte subsets ratio. Methods Two hundred and sixty-eight hospitalized children in Children Hospital of Soochow University from January 2014 to September 2015 were enrolled in this study. Peripheral blood was collected and cellular immunity was detected by flow cytometry. Pathogens were tested and patients’ clinical data was collected. Results Bronchiolitis infants were identified in 11.84% of 2264 patients in corresponding period. Prevalence rate of pathogen was 57.84%??whose sequence was??from high to low?? respiratory syncytial virus??RSV??21.27%????mycoplasma pneumoniae??MP??16.42%????Haemophilus influenzae??10.07%????Streptococcus pneumoniae??8.96%??. CD3+??CD3+CD8+ ratio of the children with bronchiolitis and without wheezing patients was lower than healthy control group. The CD4+/CD8+ ratio was the highest in bronchiolitis group??which was the lowest in healthy control group. The CD3- CD19+ ratio was higher in bronchiolitis and no-wheezing group than in healthy control group??P??0.05??. Conclusion Lymphocyte subsets disorder in brochiolitis children was samilar to that in asthma patients. Children between 6 months and 1 year old were more likely to develop bronchiolitis than the other two groups. Bronchiolitis infants may have high expression tendency of B lymphocyte??especially those with allergic symptoms. RSV is still the most common pathogen in bronchiolitis.     

2岁以下毛细支气管炎患儿临床特征与淋巴细胞亚群比值关系

目的 探究2岁以下毛细支气管炎患儿临床特征与淋巴细胞亚群比值关系。方法 以2014年1月至2015年9月在苏州大学附属儿童医院呼吸科住院诊断为毛细支气管炎的268例患儿为研究对象,入院后24 h内取静脉血进行流式检测淋巴细胞亚群比值,同时进行多病原检测,并收集其他临床资料与同龄非喘息肺炎患儿淋巴细胞亚群进行比较。结果 毛细支气管炎患儿占同期2岁以下住院病例的11.84%。病原阳性检出率57.84%,病原阳性检出排序为呼吸道合胞病毒（21.27%）、肺炎支原体（16.42%）、流感嗜血杆菌（10.07%）、肺炎链球菌（8.96%）。毛细支气管炎组和非喘息肺炎组CD3+、CD3+CD8+比值均低于正常对照组;毛细支气管炎组CD4+/CD8+比值最高,正常对照组最低,毛细支气管炎与非喘息肺炎组CD3-CD19+比值均高于正常对照组（P＜0.05）。结论 毛细支气管炎患儿存在与哮喘相似的淋巴细胞亚群失衡。6个月至1岁儿童更易发生毛细支气管炎。毛细支气管炎特别是过敏体质患儿可能存在B细胞表达水平增强倾向。呼吸道合胞病毒仍是毛细支气管炎最主要病原体。     

浅谈肺炎支原体性细支气管炎

感染性细支气管炎狭义概念是指2岁以下儿童的下呼吸道炎症和阻塞,几乎均系病毒尤其是呼吸道合胞病毒(RSV)感染引起.但肺炎支原体也可引起急性感染性细支气管炎,并可遗留闭塞性细支气管炎,其临床表现不同于传统认识的RSV毛细支气管炎.有关肺炎支原体性细支气管炎国内认识不多,许多问题尚需要进一步探讨.该文针对肺炎支原体性细支气...     

Notch信号通路与毛细支气管炎的相关性研究进展

毛细支气管炎是婴幼儿时期最常见的下呼吸道感染性疾病,其主要的病原体是呼吸道合胞病毒,是引起婴幼儿住院的主要因素之一,与哮喘的发生密切相关.但是其详细机制仍未阐明,也尚无特异性的治疗药物.近年来研究发现Notch信号通路在其发病过程中有重要作用.该文就近年来Notch信号通路与毛细支气管炎的相关性研究作一综述.     

Eleven consecutive years of respiratory syncytial virus outbreaks in Croatia

Background:  Respiratory syncytial virus (RSV) is the most common cause of severe lower respiratory tract infections (LRTI) in infants. The aim of the present study was to analyze the epidemiologic characteristics of RSV outbreaks in Croatian children.
Methods:  Over a period of 11 consecutive years (1994–2005), 3435 inpatients with acute respiratory infections (ARI) aged from birth to 10 years and were residing in Zagreb County were tested for infection with RSV and other respiratory viruses at the Virology Department, Croatian National Institute of Public Health. RSV was identified in nasopharyngeal secretions by isolation on cell culture and/or detection with monoclonal antibodies using a direct fluorescence assay.
Results:  RSV was the most common causative agent of ARI (42.2%; 658/1559) for the infants 0–6 months of age. It was also the etiologic agent of LRTI in 49% (495/1010) of infants of similar age. RSV was demonstrated in 56.5% (382/676) of infants with bronchiolitis, and in 36.5% (49/134) of those with pneumonia in this age group.
Conclusion:  The overall prevalence of RSV infection in Croatian children with acute respiratory illness, and its occurrence in various age groups, has remained stable over the past decade. RSV was found to be the most common cause of bronchiolitis occurring throughout childhood (52.7%; 482/913).