Rhinovirus illnesses during infancy predict subsequent childhood wheezing
Rhinovirus illnesses during infancy predict subsequent childhood wheezing
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DOI：
10.1016/j.jaci.2005.06.024
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发表时间：
2005-09-01
影响因子：
14.2
通讯作者：
Gern, JE
中科院分区：
文献类型：
--
作者：
Lemanske, RF;Jackson, DJ;Gern, JE
背景：婴儿期病毒性呼吸道感染对儿童早期喘息和/或过敏性疾病发展的影响尚未确定。目的：对 285 名遗传性过敏性呼吸道疾病高危儿童从出生到 3 岁之间的这些关系进行前瞻性评估。方法：通过鼻灌洗，评估婴儿期病毒性呼吸道感染的时间、严重程度和病因与 3 岁喘息之间的关系。此外，还分析了可能改变感染风险和喘息患病率的遗传和环境因素。 结果：第三年喘息的危险因素包括被动吸烟（比值比 [OR] = 2.1）、年长的兄弟姐妹（OR = 2.5）、1 岁时对食物过敏（OR = 2.0）、婴儿期任何中度至重度呼吸道疾病（OR = 3.6）和至少 1婴儿期患有呼吸道合胞病毒（RSV；OR = 3.0）、鼻病毒（OR 10）和/或非鼻病毒/RSV病原体（OR = 3.9）的喘息疾病。当考虑病毒病因时，鼻病毒感染引起的第一年喘息疾病是随后第三年喘息的最强预测因子（OR = 6.6；P < .0001）。此外，在鼻病毒季节出现喘息的婴儿中，有 63% 在出生后第三年继续出现喘息，而所有其他婴儿中这一比例仅为 20%（OR = 6.6；P < .0001）。结论：在这一过敏和哮喘风险较高的儿童群体中，学龄前儿童喘息的最重要危险因素是出现有症状的鼻病毒；婴儿期疾病根据其季节性质提供临床和预后信息。
Background: The contribution of viral respiratory infections during infancy to the development of subsequent wheezing and/ or allergic diseases in early childhood is not established.Objective: To evaluate these relationships prospectively from birth to 3 years of age in 285 children genetically at high risk for developing allergic respiratory diseases.Methods: By using nasal lavage, the relationship of timing, severity, and etiology of viral respiratory infections during infancy to wheezing in the 3rd year of life was evaluated. In addition, genetic and environmental factors that could modify risk of infections and wheezing prevalence were analyzed.Results: Risk factors for 3rd year wheezing were passive smoke exposure (odds ratio [OR] = 2.1), older siblings (OR = 2.5), allergic sensitization to foods at age 1 year (OR = 2.0), any moderate to severe respiratory illness without wheezing during infancy (OR = 3.6), and at least 1 wheezing illness with respiratory syncytial virus (RSV; OR = 3.0), rhinovirus (OR 10) and/or non-rhinovirus/RSV pathogens (OR = 3.9) during infancy. When viral etiology was considered, 1st-year wheezing illnesses caused by rhinovirus infection were the strongest predictor of subsequent 3rd year wheezing (OR = 6.6; P < .0001). Moreover, 63% of infants who wheezed during rhinovirus seasons continued to wheeze in the 3rd year of life, compared with only 20% of all other infants (OR = 6.6; P < .0001).Conclusion: In this population of children at increased risk of developing allergies and asthma, the most significant risk factor for the development of preschool childhood wheezing is the occurrence of symptomatic rhinovirus; illnesses during infancy that are clinically and prognostically informative based on their seasonal nature.