哮喘联盟

   摘要
   背景：我们知道病毒感染通常与哮喘急性发作相关，但是它对哮喘患者日常症状控制水平的影响程度仍未知。
   目的：本项目旨在研究病毒感染、宿主及环境因素与哮喘儿童患儿呼吸系统症状之间的相关性。
   方法：收集67例哮喘患儿的临床样本标本，每周收集2次，共收集10周。这些样本包括鼻腔清洗液和呼出气用以PCR检测病毒RNA、肺功能检测数据、记录用药情况及用药前三天哮喘及呼吸系统症状等。此外，还检测过敏症、螨变异原暴露情况以及血清中维他命D的水平。对以上变量数据进行混合模型回归分析。
   结果：人类鼻病毒(hRVs)在1232份个鼻腔清洗液标本中的检出率为25.5%，在呼气测试样本中的检出率则为11.5%。非- hRV病毒的检出率小于3%。鼻腔清洗液标本中人类鼻病毒的检出与采样时及采样后3－4天内的哮喘症状（咳嗽咳痰：优势比为2.0；95%可信区间为1.4－2.86，P = .0001；喘息和胸闷：优势比为2.34；95%可信区间为1.55-3.52，P < .0001）及感冒症状均相关。三种人类鼻病毒亚型（hRV-A，hRV-B和hRV-C）在症状风险上无差异。既往使用吸入性糖皮质激素而非过敏症、螨变异原暴露情况以及血清中维他命D的水平可缓解病毒感染与各哮喘症状出现的关联性。
   结论：人类鼻病毒的感染可显著增加哮喘患儿日常哮喘症状出现的风险。但是宿主、病毒的亚型以及环境因素等对病毒感染和哮喘发生症状出现两者之间的关联性影响很小或没有影响。
 

（杨冬 审校）
JAllergyClinImmunol.2014Dec1.pii:S0091-6749(14)01515-2.doi:10.1016/j.jaci.2014.10.020. [Epub ahead of print]

 

Rhinoviruses significantly affect day-to-day respiratory symptoms of children with asthma.
 

Tovey ER1, Stelzer-Braid S2, Toelle BG3, Oliver BG4, Reddel HK5, Willenborg CM6, Belessis Y7, Garden FL8, Jaffe A7, Strachan R9, Eyles D10, Rawlinson WD11, Marks GB12.
 

ABSTRACT
BACKGROUND: Viruses are frequently associated with acute exacerbations of asthma, but the extent to which they contribute to the level of day-to-day symptom control is less clear.
OBJECTIVE: We sought to explore the relationship between viral infections, host and environmental factors, and respiratory symptoms in children.
METHODS: Sixty-seven asthmatic children collected samples twice weekly for an average of 10 weeks. These included nasal wash fluid and exhaled breath for PCR-based detection of viral RNA, lung function measurements, and records of medication use and asthma and respiratory symptoms in the previous 3 days. Atopy, mite allergen exposure, and vitamin D levels were also measured. Mixed-model regression analyses were performed.
RESULTS: Human rhinoviruses (hRVs) were detected in 25.5% of 1232 nasal samples and 11.5% of breath samples. Non-hRV viruses were detected in less than 3% of samples. hRV in nasal samples was associated with asthma symptoms (cough and phlegm: odds ratio = 2.0; 95% CI = 1.4-2.86, P = .0001; wheeze and chest tightness: odds ratio = 2.34, 95% CI = 1.55-3.52, P < .0001) and with cold symptoms, as reported concurrently with sampling and 3 to 4 days later. No differences were found between the 3 hRV genotypes (hRV-A, hRV-B, and hRV-C) in symptom risk. A history of inhaled corticosteroid use, but not atopic status, mite allergen exposure, or vitamin D levels, modified the association between viruses and asthma symptoms.
CONCLUSION: The detection of nasal hRV was associated with a significantly increased risk of day-to-day asthma symptoms in children. Host, virus genotype, and environmental factors each had only a small or no effect on the relationship of viral infections to asthma symptoms.
 

JAllergyClinImmunol.2014Dec1.pii:S0091-6749(14)01515-2.doi:10.1016/j.jaci.2014.10.020. [Epub ahead of print]