支气管哮喘急性发作期儿童呼吸道病原体的多重分子检测
2010/08/20
背景：白种人儿童中，高达80%的支气管哮喘（简称哮喘）急性发作与上呼吸道病毒感染相关，而亚裔儿童不同呼吸道病原体的相对重要性及相关微生物学资料尚不清楚。本研究旨在阐明哮喘急性发作期的香港儿童呼吸道感染的流行病学情况。
方法：纳入了209例年龄在3-18周岁的哮喘急性发作期儿童，另设立77例哮喘稳定期儿童作为对照。采用全球哮喘创议（GINA）对哮喘急性发作期病情程度进行评估，6岁以上的受试者进行了呼出气一氧化氮（NO）及肺功能测量，并采用巢式多重聚合酶链反应（nested multiplex polymerase chain reaction, PCR）对20种不同呼吸道病原体进行了检测。
结果：有105例（占51.0%）的受试者检测到呼吸道病原体。呼吸道病原体与哮喘急性发作相关（OR=2.77, 95%CI=[1.51, 5.11])。在哮喘急性发作期儿童中，人类鼻病毒（HRV）感染较为普遍（OR=2.38, 95%CI=[1.09, 5.32]; P=0.018）。所有的其它病原体或合并感染与哮喘急性发作无相关性。这些呼吸道感染中，无任何一种与哮喘急性发作病情程度存在相关性（P均>0.15）。在2007-2008年冬季的HRV高峰季节，该病毒在哮喘急性发作期儿童中的检出率为46.4%。
结论：在儿童哮喘急性发作期，呼吸道病毒感染相当普遍，而HRV为我们所研究受试对象中最为重要的病原体。呼吸道病毒感染是哮喘急性发作的触发因子，但其与哮喘急性发作期病情严重程度无关。
（王刚 四川大学华西医院中西医结合科呼吸组 610041 摘译）
（Chest. 2010; 137(2): 348-354）
（Chest. 2010; 137(2): 348-354）
Multiplex molecular detection of respiratory pathogens in children with asthma exacerbation
Leung TF, To MY, Yeung AM, Wong YS, Wong GWK, Chan PKS.
Chest. 2010; 137(2): 348-354
Background: Up to 80% of asthma exacerbations in white children are associated with viral upper respiratory infections. The relative importance of different respiratory pathogens and relevant microbiological data in Asian children are unclear. This study elucidated the epidemiology of respiratory infections in Hong Kong children with asthma exacerbation.
Methods: A total of 209 children aged 3-18 years with asthma exacerbations and 77 controls with stable asthma were recruited. The severity of asthma exacerbations was assessed according to Global Initiative for Asthma guideline, and subjects aged 6 years or older performed exhaled nitric oxide and spirometric measurements. Nested multiplex polymerase chain reaction was used to detect 20 different respiratory pathogens.
Results: Respiratory pathogens were detected in 105 (51.0%) subjects. The presence of any respiratory pathogen was associated with asthma exacerbation (odds ratio [OR], 2.77; 95% CI, 1.51-5.11; P <.001). Specifi cally, human rhinovirus (HRV) infection was more common among children with asthma exacerbation (OR, 2.38; 95% CI, 1.09-5.32; P = .018). All other pathogens or coinfections were not associated with asthmatic attacks. None of these respiratory infections was associated with the severity of asthma exacerbation ( P > .15 for all). During peak HRV season in the winter of 2007 to 2008, this virus was detected in 46.4% of children with asthma exacerbations.
Conclusions: Respiratory viral infections are commonly found in children with asthma exacerbation, with HRV being the most important pathogen in our patients. Respiratory viral infection is a triggering factor for asthma exacerbation but does not correlate with its severity.
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一氧化碳污染与哮喘成人肺功能下降有关
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支气管反应性增加少年儿童体力活动下降
