鼻病毒感染引起的急性哮喘和哮喘增强型流感病毒引起的哮喘的区别
2018/03/05
摘要
背景：鼻病毒（RV）是哮喘发作的一个既定触发因素，而哮喘与流感病毒（IFV）并没有这样的关联。
目的：在精密医学的背景下，我们假设IFV感染致病条件与RV本质上是不同的，我们通过伴有呼吸系统症状和/或发热的儿童的RV / IFV阳性或阴性比值，来评估其这部分儿童的临床特征。
方法:招募因流感而住院的6个月到13岁1207名儿童进行横断面研究。收集的信息包括人口统计学、病史、症状/体征/目前诊断和治疗。鼻分泌物使用PCR技术检测IFV /RV。使用调整后的logistic回归模型分析。
结果:RV阳性与哮喘样表现有关，包括喘息增加、呼吸费力或急性哮喘发作，发热、呕吐减少。相反，IFV阳性的孩子出现喘、呼吸费力、哮喘急性哮喘发作少，而他们更频繁的表现发热。那些有哮喘史的儿童，这两种病毒均可引起喘息，然而，IFV更广泛及严重表现为发热、肺部罗音，肋间肌肉萎缩和淋巴结肿大。这些症状在RV阳性哮喘患者中少见，全身症状较少，主要以咳嗽为主。
结论和临床相关性：在有呼吸道症状和/或发烧的孩子，是RV而不是IFV与喘息和哮喘样表现相关。在那些有哮喘病史的孩子，IFV多引起更广义的和严重的疾病，可以更好地描述为“哮喘增强性流感病毒”而不是“引起哮喘”。在流行病学研究设计中应考虑这些病毒引起的急性病症的差异。
Distinction between rhinovirus-induced acute asthma and asthma-augmented influenza infection
Guibas GV, Tsolia M, Christodoulou I, Stripeli F, Sakkou Z, Papadopoulos NG.
Abstract
BACKGROUND: Rhinovirus (RV) is an established trigger of asthma attacks, whereas such a link is less consistent for influenza virus (IFV).
OBJECTIVE: In the context of precision medicine, we hypothesized that IFV infection may cause a condition essentially different from RV, and we investigated this by evaluating clinical characteristics of RV/IFV-positive and -negative children with respiratory symptoms and/or fever.
METHODS: 1207 children, 6-months to 13-years old, hospitalized for flu-like illness were recruited in this cross-sectional study. Collected information included demographics, medical history, symptoms/physical findings/diagnosis at presentation, and treatment. Nasal secretions were PCR-tested for IFV/RV. Associations were evaluated with adjusted logistic regression models.
RESULTS: RV positivity was associated with an asthma-like presentation, including increased wheeze/effort of breathing/diagnosis of acute asthma, and decreased fever/vomiting. Conversely, IFV+ children presented with less wheeze/effort of breathing/diagnosis of acute asthma, while they were more frequently febrile. In those with previous asthma history, both viruses induced wheeze, however, IFV was uniquely associated with a more generalised and severe presentation including fever, rales, intercostal muscle retractions and lymphadenopathy. These symptoms were not seen in RV+ asthmatics, who had fewer systemic signs and more cough.
CONCLUSIONS AND CLINICAL RELEVANCE: In children with respiratory symptoms and/or fever, RV but not IFV is associated with wheeze and an asthma-like presentation. In those with an asthma history, IFV causes more generalised and severe disease that may be better described as 'asthma-augmented influenza' rather than an 'asthma attack'. Differences in the acute conditions caused by these viruses should be considered in the design of epidemiological studies.
背景：鼻病毒（RV）是哮喘发作的一个既定触发因素，而哮喘与流感病毒（IFV）并没有这样的关联。
目的：在精密医学的背景下，我们假设IFV感染致病条件与RV本质上是不同的，我们通过伴有呼吸系统症状和/或发热的儿童的RV / IFV阳性或阴性比值，来评估其这部分儿童的临床特征。
方法:招募因流感而住院的6个月到13岁1207名儿童进行横断面研究。收集的信息包括人口统计学、病史、症状/体征/目前诊断和治疗。鼻分泌物使用PCR技术检测IFV /RV。使用调整后的logistic回归模型分析。
结果:RV阳性与哮喘样表现有关，包括喘息增加、呼吸费力或急性哮喘发作，发热、呕吐减少。相反，IFV阳性的孩子出现喘、呼吸费力、哮喘急性哮喘发作少，而他们更频繁的表现发热。那些有哮喘史的儿童，这两种病毒均可引起喘息，然而，IFV更广泛及严重表现为发热、肺部罗音，肋间肌肉萎缩和淋巴结肿大。这些症状在RV阳性哮喘患者中少见，全身症状较少，主要以咳嗽为主。
结论和临床相关性：在有呼吸道症状和/或发烧的孩子，是RV而不是IFV与喘息和哮喘样表现相关。在那些有哮喘病史的孩子，IFV多引起更广义的和严重的疾病，可以更好地描述为“哮喘增强性流感病毒”而不是“引起哮喘”。在流行病学研究设计中应考虑这些病毒引起的急性病症的差异。
(中日友好医院医院呼吸与危重症一部 李红雯 摘译 林江涛 审校)
(Clin Exp Allergy. 2018 Feb 23. doi: 10.1111/cea.13124.)
(Clin Exp Allergy. 2018 Feb 23. doi: 10.1111/cea.13124.)
Distinction between rhinovirus-induced acute asthma and asthma-augmented influenza infection
Guibas GV, Tsolia M, Christodoulou I, Stripeli F, Sakkou Z, Papadopoulos NG.
Abstract
BACKGROUND: Rhinovirus (RV) is an established trigger of asthma attacks, whereas such a link is less consistent for influenza virus (IFV).
OBJECTIVE: In the context of precision medicine, we hypothesized that IFV infection may cause a condition essentially different from RV, and we investigated this by evaluating clinical characteristics of RV/IFV-positive and -negative children with respiratory symptoms and/or fever.
METHODS: 1207 children, 6-months to 13-years old, hospitalized for flu-like illness were recruited in this cross-sectional study. Collected information included demographics, medical history, symptoms/physical findings/diagnosis at presentation, and treatment. Nasal secretions were PCR-tested for IFV/RV. Associations were evaluated with adjusted logistic regression models.
RESULTS: RV positivity was associated with an asthma-like presentation, including increased wheeze/effort of breathing/diagnosis of acute asthma, and decreased fever/vomiting. Conversely, IFV+ children presented with less wheeze/effort of breathing/diagnosis of acute asthma, while they were more frequently febrile. In those with previous asthma history, both viruses induced wheeze, however, IFV was uniquely associated with a more generalised and severe presentation including fever, rales, intercostal muscle retractions and lymphadenopathy. These symptoms were not seen in RV+ asthmatics, who had fewer systemic signs and more cough.
CONCLUSIONS AND CLINICAL RELEVANCE: In children with respiratory symptoms and/or fever, RV but not IFV is associated with wheeze and an asthma-like presentation. In those with an asthma history, IFV causes more generalised and severe disease that may be better described as 'asthma-augmented influenza' rather than an 'asthma attack'. Differences in the acute conditions caused by these viruses should be considered in the design of epidemiological studies.
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关于农村学校哮喘远程医疗教育项目的调查结果
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