Rhinovirus and respiratory syncytial virus in wheezing children requiring emergency care - IgE and eosinophil analyses
Rhinovirus and respiratory syncytial virus in wheezing children requiring emergency care - IgE and eosinophil analyses
复制标题
DOI：
10.1164/ajrccm.159.3.9801052
复制
发表时间：
1999-03-01
影响因子：
24.7
通讯作者：
Heymann, PW
中科院分区：
文献类型：
--
作者：
Rakes, CP;Arruda, E;Heymann, PW
这项横断面急诊科研究包括70名喘息儿童和59名对照受试者（2个月至16岁），研究呼吸道病毒的患病率及其与年龄、特应性状态和嗜酸性粒细胞标志物的关系。培养鼻洗液中的呼吸道病毒，测定呼吸道合胞病毒（RSV）抗原，并使用逆转录-PCR（RT-PCR）检测冠状病毒和鼻病毒RNA。还评价了鼻洗液和血清中的嗜酸性粒细胞数量和嗜酸性粒细胞阳离子蛋白（ECP），沿着血清中的总IgE和特异性IgE抗体。在82%（18/22）的2岁以下喘息婴儿和83%（40/48）的较大喘息儿童中检测到呼吸道病毒。主要病原体为婴幼儿呼吸道合胞病毒（68%喘息受试者检出）和老年喘息儿童鼻病毒（71%），两者均与喘息密切相关（p < 0.005）。RSV主要局限于小于24个月的喘息儿童，但鼻病毒在所有婴儿中的41%和在年龄大于2岁的非喘息对照组中的35%中通过KT-PCR检测到。2岁以后，鼻病毒RT-PCR检测阳性、血清放射性过敏原吸附试验（RAST）阳性、鼻嗜酸性粒细胞增多或鼻ECP升高的儿童发生喘息的几率最大（比值比分别为17、21和25）。这项研究的结果表明，绝大多数儿童期（2 - 16岁）的紧急喘息性疾病可能与鼻病毒感染有关，这些喘息性疾病最有可能发生在鼻病毒感染伴特应性或嗜酸性粒细胞性气道炎症的患者中。
This cross-sectional emergency department study of 70 wheezing children and 59 control subjects (2 mo to 16 yr of age) examined the prevalence of respiratory viruses and their relationship to age, atopic status, and eosinophil markers. Nasal washes were cultured for respiratory viruses, assayed for respiratory syncytial virus (RSV) antigen, and tested for coronavirus and rhinovirus RNA using reverse transcription-PCR (RT-PCR). Also evaluated were eosinophil numbers and eosinophil cationic protein (ECP) in both nasal washes and serum, along with total IgE and specific IgE antibody in serum. Respiratory viruses were detected in 82% (18 of 22) of wheezing infants younger than 2 yr of age and in 83% (40 of 48) of older wheezing children. The predominant pathogens were RSV in infants (detected in 68% of wheezing subjects) and rhinovirus in older wheezing children (71%), and both were strongly associated with wheezing (p < 0.005). RSV was largely limited to wheezing children younger than 24 mo of age, but rhinovirus was detected by KT-PCR in 41% of all infants and in 35% of nonwheezing control subjects older than 2 yr of age. After 2 yr of age the strongest odds for wheezing were observed among those who had a positive RT-PCR test for rhinovirus together with a positive serum radioallergosorbent testing (RAST), nasal eosinophilia, or elevated nasal ECP (odds ratios = 17, 21, and 25, respectively). Results from this study demonstrate that a large majority of emergent wheezing illnesses during childhood (2 to 16 yr of age) can be linked to infection with rhinovirus, and that these wheezing attacks are most likely in those who have rhinovirus together with evidence of atopy or eosinophilic airway inflammation.