妊娠期宏量元素和威胁儿童生命的呼吸道合胞病毒感染
2013/07/10
合理性：在世界范围内，呼吸道合胞病毒（RSV）是引起婴儿住院和死亡的一个重要原因。大部分RSV致死病例发生在发展中国家，而危及生命的疾病负担和危险因素还不清楚。
目的：研究者定义了危及生命的负担（血氧饱和度£87%）和致死性RSV感染，识别危及住院患儿生命的疾病危险因素。对于怀孕期间饮食习惯影响的研究给予特别强调。我们推测，不同于我们祖先的饮食偏好将对儿童的肺健康产生负面影响。例如，饮食中富含碳水化合物是近千年的一个标志和低收入人群的特征，是危及生命的RSV的沉重负担。
方法：在阿根廷，在RSV流行季节，对56560名2岁以下的流域人口中进行了前瞻性研究。所有具有呼吸道症状和血氧饱和度小于93%的儿童都纳入研究。
测量和主要结果：在存在呼吸道感染的1293例儿童中，797名（61.6%）感染RSV：其中有106例有危及生命的疾病；2岁以上为千分之1.9（95%置信区间为千分之1.5-2.2）。共有22名住院儿童死亡（9名RSV阳性），26名由于急性呼吸道感染在家中死亡（14名归因于RSV）；所有的都小于1岁。RSV的婴儿年死亡率为千分之0.7（95%置信区间为千分之0.4-1.1）。危及生命的疾病与怀孕期间碳水化合物摄入量呈剂量依赖关系。调整的OR值为3.29（95%CI，1.15-9.44）到7.36（95%CI，2.41-22.5）而不是最低四分位数。
结论：在发展中国家，危及生命及致死性RSV感染是婴儿的严重负担。怀孕期间富含碳水化合物的饮食与这些严重的后果相关。
Macronutrients during Pregnancy and Life-Threatening Respiratory Syncytial Virus Infections in Children
RATIONALE:Respiratory syncytial virus (RSV) is an important cause of hospitalization and death in infants worldwide. Most RSV deaths occur in developing countries, where burden and risk factors for life-threatening illness are unclear.
OBJECTIVES: W e defined the burden of life-threatening (O2 saturation[O2sat] < 87%) and fatal RSV infection, and characterized risk factors for life-threatening disease in hospitalized children. Special emphasis was placed on studying the impact of dietary habits during pregnancy. We hypothesized that dietary preferences, differing from those of our remote ancestors, would negatively impact children’s pulmonary health. For instance, a diet rich in carbohydrates is a signature of recent millennia and typical of low-income populations, heavily burdened by life-threatening RSV disease.
METHODS: Prospective study in a catchment population of 56,560 children under 2 years of age during the RSV season in Argentina. All children with respiratory signs and O2 sat less than 93% on admission were included.
MEASUREMENTS AND MAIN RESULTS: Among 1,293 children with respira-tory infections, 797(61.6%) were infected with RSV: 106 of these had life-threatening disease; 1.9 per 1,000 children (95% confidence interval [CI], 1.5–2.2/1,000) under 24 months. A total of 22 hospitalized children died (9 RSV), 26 died at home due to acute respiratory infection (14 attributed to RSV); all were under 12 months old. The annual attributable mortality rate for RSV was 0.7 per 1,000 infants (95% CI, 0.4–1.1/1,000). Life-threatening disease was dose –dependently associated with carbohydrate ingestion during pregnancy (adjusted odds ratio from 3.29 [95% CI, 1.15–9.44] to 7.36 [95% CI, 2.41–22.5]versus the lowest quartile).
CONCLUSIONS: Life-threatening and fatal RSV infections are a heavy burden on infants in the developing world. Diets rich in carbohydrates during pregnancy are associated with these severe outcomes.
Am J Respir Crit Care Med 2013;187(9):983-990
目的：研究者定义了危及生命的负担（血氧饱和度£87%）和致死性RSV感染，识别危及住院患儿生命的疾病危险因素。对于怀孕期间饮食习惯影响的研究给予特别强调。我们推测，不同于我们祖先的饮食偏好将对儿童的肺健康产生负面影响。例如，饮食中富含碳水化合物是近千年的一个标志和低收入人群的特征，是危及生命的RSV的沉重负担。
方法：在阿根廷，在RSV流行季节，对56560名2岁以下的流域人口中进行了前瞻性研究。所有具有呼吸道症状和血氧饱和度小于93%的儿童都纳入研究。
测量和主要结果：在存在呼吸道感染的1293例儿童中，797名（61.6%）感染RSV：其中有106例有危及生命的疾病；2岁以上为千分之1.9（95%置信区间为千分之1.5-2.2）。共有22名住院儿童死亡（9名RSV阳性），26名由于急性呼吸道感染在家中死亡（14名归因于RSV）；所有的都小于1岁。RSV的婴儿年死亡率为千分之0.7（95%置信区间为千分之0.4-1.1）。危及生命的疾病与怀孕期间碳水化合物摄入量呈剂量依赖关系。调整的OR值为3.29（95%CI，1.15-9.44）到7.36（95%CI，2.41-22.5）而不是最低四分位数。
结论：在发展中国家，危及生命及致死性RSV感染是婴儿的严重负担。怀孕期间富含碳水化合物的饮食与这些严重的后果相关。
（首都儿科研究所 房娟 摘译）
Am J Respir Crit Care Med 2013;187(9):983-990
Am J Respir Crit Care Med 2013;187(9):983-990
Macronutrients during Pregnancy and Life-Threatening Respiratory Syncytial Virus Infections in Children
RATIONALE:Respiratory syncytial virus (RSV) is an important cause of hospitalization and death in infants worldwide. Most RSV deaths occur in developing countries, where burden and risk factors for life-threatening illness are unclear.
OBJECTIVES: W e defined the burden of life-threatening (O2 saturation[O2sat] < 87%) and fatal RSV infection, and characterized risk factors for life-threatening disease in hospitalized children. Special emphasis was placed on studying the impact of dietary habits during pregnancy. We hypothesized that dietary preferences, differing from those of our remote ancestors, would negatively impact children’s pulmonary health. For instance, a diet rich in carbohydrates is a signature of recent millennia and typical of low-income populations, heavily burdened by life-threatening RSV disease.
METHODS: Prospective study in a catchment population of 56,560 children under 2 years of age during the RSV season in Argentina. All children with respiratory signs and O2 sat less than 93% on admission were included.
MEASUREMENTS AND MAIN RESULTS: Among 1,293 children with respira-tory infections, 797(61.6%) were infected with RSV: 106 of these had life-threatening disease; 1.9 per 1,000 children (95% confidence interval [CI], 1.5–2.2/1,000) under 24 months. A total of 22 hospitalized children died (9 RSV), 26 died at home due to acute respiratory infection (14 attributed to RSV); all were under 12 months old. The annual attributable mortality rate for RSV was 0.7 per 1,000 infants (95% CI, 0.4–1.1/1,000). Life-threatening disease was dose –dependently associated with carbohydrate ingestion during pregnancy (adjusted odds ratio from 3.29 [95% CI, 1.15–9.44] to 7.36 [95% CI, 2.41–22.5]versus the lowest quartile).
CONCLUSIONS: Life-threatening and fatal RSV infections are a heavy burden on infants in the developing world. Diets rich in carbohydrates during pregnancy are associated with these severe outcomes.
Am J Respir Crit Care Med 2013;187(9):983-990
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肥胖与哮喘：是合并存在还是因果关系？一篇关于此问题的系统综述
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花粉和化学污染与过敏性鼻窦炎或哮喘的关系(南匈牙利赛格德，1999年-2007年)
