Physiologic risk factors for respiratory viral infections and immunoprophylaxis for respiratory syncytial virus in young children with congenital heart disease
Physiologic risk factors for respiratory viral infections and immunoprophylaxis for respiratory syncytial virus in young children with congenital heart disease
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DOI：
10.1097/01.inf.0000108220.94201.1a
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发表时间：
2004-01-01
影响因子：
3.6
通讯作者：
Cabalka, AK
中科院分区：
文献类型：
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作者：
Cabalka, AK
背景与一般人群相比，患有先天性心脏病（CHD）的婴儿和儿童感染呼吸道合胞病毒（RSV）及其固有并发症的风险增加。RSV感染增加年轻CHD患者呼吸系统并发症的发病率。为了指导降低CHD患者RSV相关风险的策略，对严重RSV的易感因素以及预防的实验方法进行了综述。可能加重年轻CHD患者呼吸系统疾病不良反应的风险因素包括基线时心肺功能受损、肺力学改变、潜在紫绀和/或肺动脉高压以及通气-灌注不匹配。此外，患有此类疾病的患者发生RSV下呼吸道感染的风险增加，使得CHD患者的RSV预防成为一个重要目标。由于RSV主动免疫的有效性和安全性尚未确定，因此研究了许多被动免疫预防的方法。帕利珠单抗（一种人源化鼠单克隆抗F糖蛋白抗体制剂）每月一次预防治疗可使CHD儿童的住院率降低45%，住院时间和氧气使用量也降低45%。因此，在具有血流动力学显著性CHD的年轻患者中应考虑帕利珠单抗预防治疗。
Background. Infants and children with congenital heart disease (CHD) are a population at increased risk for infection with respiratory syncytial virus (RSV) and its inherent complications compared with the general population. RSV infection increases morbidity from respiratory complications in young CHD patients.Methods. In an effort to guide strategies for reducing RSV-associated risk in patients with CHD, predisposing factors for severe RSV as well as experimental approaches for prevention were reviewed.Conclusions. Risk factors that may exacerbate the adverse effects of respiratory disease in young CHD patients include compromised cardiorespiratory status at baseline, altered pulmonary mechanics, potential cyanosis and/or pulmonary hypertension and ventilation-perfusion mismatch. Furthermore patients with such conditions are at increased risk from RSV lower respiratory tract infection, making RSV prevention in patients with CHD an important goal. Because the efficacy and safety of active immunization for RSV have not yet been established, a number of approaches toward passive immunoprophylaxis have been investigated. Monthly prophylaxis with palivizumab, a humanized murine monoclonal anti-F glycoprotein antibody preparation, reduced the rate of hospitalization in children with CHD by 45%, as well as hospital time and oxygen use in those admitted. Thus palivizumab prophylaxis should be considered in young patients with hemodynamically significant CHD.