Severe bronchiolitis profiles and risk of recurrent wheeze by age 3 years.
Severe bronchiolitis profiles and risk of recurrent wheeze by age 3 years.
复制标题
DOI：
10.1016/j.jaci.2018.08.043
复制
发表时间：
2019-04
期刊：
影响因子：
--
通讯作者：
Camargo CA Jr
中科院分区：
文献类型：
--
作者：
Dumas O;Hasegawa K;Mansbach JM;Sullivan AF;Piedra PA;Camargo CA Jr
更好地了解细支气管炎的异质性可能有助于阐明其与反复喘息和哮喘发展的关系。通过聚类方法识别严重细支气管炎特征，并首次研究它们与过敏/炎症生物标志物的关联；鼻咽部微生物群； 3岁时出现反复喘息。我们分析了一项美国 17 中心前瞻性队列研究的数据，该研究纳入了 921 名因细支气管炎住院的婴儿（年龄 <1 岁）（2011-2014 年冬季）并进行了住院后随访。根据临床因素和病毒病因，通过潜在类别分析确定基线（住院）的严重细支气管炎情况。使用住院 24 小时内收集的样本测定血液生物标志物和鼻咽微生物群谱。 3岁时反复喘息的定义是根据出院后家长报告的呼吸问题发作而定。确定了三种严重细支气管炎特征：A 型（15%），其特征是婴儿期有呼吸问题/湿疹病史和非 RSV（主要是鼻病毒）感染； B 型 (49%) 具有最大的 RSV 感染概率，类似于典型的 RSV 细支气管炎； C组（36%），病情最严重。 A型婴儿的嗜酸性粒细胞计数较高，抗菌素水平较高，嗜血杆菌占优势或莫拉氏菌占优势的微生物群比例较高。与 B 型相比，我们观察到 A 型儿童发生反复喘息的风险显着增加（风险比 2.64；95% CI 1.90–3.68），而 C 型儿童的风险比较小（1.51；1.14–2.01）。尽管需要更长时间的随访，但我们的结果可能有助于在因细支气管炎住院的儿童中确定患哮喘风险特别高的亚组。通过聚类方法识别的严重细支气管炎特征与过敏和炎症生物标志物、鼻咽微生物群特征以及 3 岁时出现复发性喘息的风险存在差异相关。
A better understanding of bronchiolitis heterogeneity may help clarify its relationship with the development of recurrent wheezing and asthma. To identify severe bronchiolitis profiles by a clustering approach, and to investigate for the first time their association with allergy/inflammatory biomarkers; nasopharyngeal microbiota; and development of recurrent wheezing by age 3 years. We analyzed data from a prospective, 17-center U.S. cohort study of 921 infants (age <1 year) hospitalized with bronchiolitis (2011–2014 winters) with post-hospitalization follow-up. Severe bronchiolitis profiles at baseline (hospitalization) were determined by latent class analysis, based on clinical factors and viral etiology. Blood biomarkers and nasopharyngeal microbiota profiles were determined using samples collected within 24h of hospitalization. Recurrent wheezing by age 3 years was defined based on parental report of breathing problem episodes post-discharge. Three severe bronchiolitis profiles were identified: profile A (15%), characterized by history of breathing problems/eczema during infancy and non-RSV (mostly rhinovirus) infection; profile B (49%) with the largest probability of RSV infection and which resembled classic RSV-bronchiolitis; and profile C (36%), the most severely ill group. Profile A infants had higher eosinophil counts, higher cathelicidin levels, and elevated proportions of Haemophilusdominant or Moraxella-dominant microbiota profile. Compared to profile B, we observed significantly increased risk of developing recurrent wheezing in children with profile A (hazard ratio 2.64; 95% CI 1.90–3.68), and, to a lesser extent, with profile C (1.51; 1.14–2.01). Although longer follow-up is needed, our results may help identify, among children hospitalized for bronchiolitis, subgroups with particularly elevated risk of developing asthma. Severe bronchiolitis profiles identified by a clustering approach were differentially associated with allergy and inflammatory biomarkers, nasopharyngeal microbiota profiles, and the risk of developing recurrent wheezing by age 3 years.
登录
查看更多内容
影响因子：
6.1
作者：
Karakoc, F;Remes, ST;Wright, AL
通讯作者：
Wright, AL
DOI：
10.1164/rccm.201405-0901pp
发表时间：
2015-01-01
影响因子：
24.7
作者：
Feldman, Amy S.;He, Yuan;Hartert, Tina V.
通讯作者：
Hartert, Tina V.
影响因子：
14.2
作者：
Hose, Alexander J.;Depner, Martin;Frey, Urs
通讯作者：
Frey, Urs
影响因子：
10
作者：
Dumas O;Mansbach JM;Jartti T;Hasegawa K;Sullivan AF;Piedra PA;Camargo CA Jr
通讯作者：
Camargo CA Jr
影响因子：
158.5
作者：
Bisgaard, Hans;Hermansen, Mette Northman;Pipper, Christian Bressen
通讯作者：
Pipper, Christian Bressen