Wheezing rhinovirus illnesses in early life predict asthma development in high-risk children
Wheezing rhinovirus illnesses in early life predict asthma development in high-risk children
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DOI：
10.1164/rccm.200802-309oc
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发表时间：
2008-10-01
影响因子：
24.7
通讯作者：
Lemanske, Robert F., Jr.
中科院分区：
文献类型：
--
作者：
Jackson, Daniel J.;Gangnon, Ronald E.;Lemanske, Robert F., Jr.
理由：婴儿时期病毒引起的喘息发作通常先于哮喘的发展。感染特定的病毒病原体是否会导致未来哮喘风险的差异尚不完全清楚。目的：明确特定病毒性疾病与儿童早期哮喘发展的关系。方法：对259例儿童从出生至6岁进行前瞻性随访。通过鼻腔灌洗、培养和多重逆转录-聚合酶链反应来评估儿童早期特定病毒性喘息呼吸系统疾病的病因和时间。分析了这些病毒特异性喘息疾病和其他危险因素与哮喘发展的关系。测量和主要结果：在90%的喘息疾病中确定了病毒病因。从出生到3岁，呼吸道合胞病毒（RSV）（比值比[OR]为2.6）、鼻病毒（RV）（比值比为9.8）或RV和RSV兼有（OR, 10）的喘息与6岁时哮喘风险增加相关。在第1年，RV喘息（OR, 2.8）和空气过敏原致敏（OR, 3.6）分别增加了6岁时哮喘的风险。到3岁时，伴有RV的喘息（OR, 25.6）与6岁时哮喘的相关性高于空气过敏原致敏（OR, 3.4）。近90%（26 / 30）在第3年患有RV的儿童在6岁时患有哮喘。结论：在婴幼儿门诊病毒性喘息疾病中，RV感染引起的疾病是高危出生队列中6岁时哮喘后续发展的最重要预测因素。
Rationale: Virus-induced wheezing episodes in infancy often precede the development of asthma. Whether infections with specific viral pathogens confer differential future asthma risk is incompletely understood.Objectives: To define the relationship between specific viral illnesses and early childhood asthma development.Methods: A total of 259 children were followed prospectively from birth to 6 years of age. The etiology and timing of specific viral wheezing respiratory illnesses during early childhood were assessed using nasal lavage, culture, and multiplex reverse transcriptase-polymerase chain reaction. The relationships of these virus-specific wheezing illnesses and other risk factors to the development of asthma were analyzed.Measurements and Main Results: Viral etiologies were identified in 90% of wheezing illnesses. From birth to age 3 years, wheezing with respiratory syncytial virus (RSV) (odds ratio [OR), 2.6), rhinovirus (RV) (OR, 9.8), or both RV and RSV (OR, 10) was associated with increased asthma risk at age 6 years. In Year 1, both RV wheezing (OR, 2.8) and aeroallergen sensitization (OR, 3.6) independently increased asthma risk at age 6 years. By age 3 years, wheezing with RV (OR, 25.6) was more strongly associated with asthma at age 6 years than aeroallergen sensitization (OR, 3.4). Nearly 90% (26 of 30) of children who wheezed with RV in Year 3 had asthma at 6 years of age.Conclusions: Among outpatient viral wheezing illnesses in infancy and early childhood, those caused by RV infections are the most significant predictors of the subsequent development of asthma at age 6 years in a high-risk birth cohort.