Host and viral factors associated with severity of human rhinovirus-associated infant respiratory tract illness
Host and viral factors associated with severity of human rhinovirus-associated infant respiratory tract illness
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DOI：
10.1016/j.jaci.2010.11.041
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发表时间：
2011-04-01
影响因子：
14.2
通讯作者：
Hartert, Tina V.
中科院分区：
文献类型：
--
作者：
Miller, E. Kathryn;Williams, John V.;Hartert, Tina V.
背景资料：严重人鼻病毒（HRV）相关婴儿疾病的危险因素尚不清楚。目的：我们试图研究HRV感染在婴儿呼吸道疾病中的作用，并评估病毒和宿主危险因素对HRV相关疾病严重程度的影响。我们使用了一个前瞻性队列，在秋季因急性上呼吸道或下呼吸道疾病住院或门诊访视期间入组的既往健康婴儿-2004-2008年春季。疾病严重程度通过使用有序细支气管炎严重程度评分来确定，评分越高表明疾病越严重。采用实时荧光定量RT-PCR方法检测HRV。结果：630例毛细支气管炎或上呼吸道疾病（URI）的婴儿中，162例（26%）有HRV感染; HRV感染与18%的毛细支气管炎病例和47%的URI病例相关。在HRV感染的婴儿中，104例（64%）仅为HRV感染。与更严重的HRV相关疾病相关的宿主因素包括特应性的母亲和家族史（中位评分为3.5 [四分位距[IQR]，1.0-7.8] vs 2.0 [IQR，1.0-5.2]和3.5 [IQR，1.0-7.5] vs 2.0 [IQR，0-4.0]）。在校正的分析中，母亲的特应性病史增加了更严重的HRV相关性细支气管炎的风险（比值比，2.39; 95%CI，1.14-4.99; P = 0.02）。在一个相似的模型中，母亲哮喘也与HRV相关细支气管炎严重程度更高相关（比值比，2.49，95% CI，1.10-5.67; P = .03）。在HRV感染的患者中，35%有HRVA，6%有HRVB，和30%有HRVC。结论：HRV感染是一个常见的原因毛细支气管炎和URI在以前健康的足月婴儿需要住院治疗或不定期门诊就诊。在HRV感染患者中观察到大量的病毒遗传多样性，并且主要群体因季节和年份而异。宿主因素，包括母体特应性，与更严重的婴儿HRV相关疾病有关。（J Allergy Clin Immunol 2011;127：883-91.）
Background: Risk factors for severe human rhinovirus (HRV)associated infant illness are unknown.Objectives: We sought to examine the role of HRV infection in infant respiratory tract illness and assess viral and host risk factors for HRV-associated disease severity.Methods: We used a prospective cohort of term, previously healthy infants enrolled during an inpatient or outpatient visit for acute upper or lower respiratory tract illness during the fall-spring months of 2004-2008. Illness severity was determined by using an ordinal bronchiolitis severity score, with higher scores indicating more severe disease. HRV was identified by means of real-time RT-PCR. The VP4/VP2 region from HRV-positive specimens was sequenced to determine species.Results: Of 630 infants with bronchiolitis or upper respiratory tract illnesses (URIs), 162 (26%) had HRV infection; HRV infection was associated with 18% of cases of bronchiolitis and 47% of cases of URI. Among infants with HRV infection, 104 (64%) had HRV infection alone. Host factors associated with more severe HRV-associated illness included a maternal and family history of atopy (median score of 3.5 [interquartile range [IQR], 1.0-7.8] vs 2.0 [IQR, 1.0-5.2] and 3.5 [IQR, 1.0-7.5] vs 2.0 [IQR, 0-4.0]). In adjusted analyses maternal history of atopy conferred an increase in the risk for more severe HRVassociated bronchiolitis (odds ratio, 2.39; 95% CI, 1.14-4.99; P = .02). In a similar model maternal asthma was also associated with greater HRV-associated bronchiolitis severity (odds ratio, 2.49, 95% CI, 1.10-5.67; P = .03). Among patients with HRV infection, 35% had HRVA, 6% had HRVB, and 30% had HRVC.Conclusion: HRV infection was a frequent cause of bronchiolitis and URIs among previously healthy term infants requiring hospitalization or unscheduled outpatient visits. Substantial viral genetic diversity was seen among the patients with HRV infection, and predominant groups varied by season and year. Host factors, including maternal atopy, were associated with more severe infant HRV-associated illness. (J Allergy Clin Immunol 2011;127:883-91.)