Poulsen Anja, Stensballe Lone Graff, Nielsen Jens, Benn Christine Stabell, Balde Aliu, Roth Adam, Lisse Ida Maria, Aaby Peter
Projecto de Saude de Bandim, Guinea-Bissau, Copenhagen, Denmark.
Pediatr Infect Dis J. 2006 Nov;25(11):1025-31. doi: 10.1097/01.inf.0000243214.80794.3a.
The study aimed to investigate long-term consequences of respiratory syncytial virus (RSV) positive acute lower respiratory tract infection (ALRI) in a low-income country according to severity of the initial infection.
The study was a 1:1 matched case-control study of 335 RSV case children and 335 control children. The mean age of RSV ALRI was 0.9 year and at follow-up, 6.8 years. Case children were identified at the hospital and in the community with an antigen and an IgM test to diagnose RSV. Severe RSV infection was defined when a child was treated at the hospital, whereas disease was assumed less severe when a child was diagnosed at home and received no care in the hospital.
At follow-up, forced expiratory volume in 1 second (FEV1) and peak flow were significantly lower in case children (odds ratio [OR] = 0.28; 95% confidence interval [CI] 0.10-0.79), the effect being particularly marked for children with severe RSV. Bronchitis at follow-up was reported more frequently among the case children with severe disease. Fewer case children had a positive skin-prick test for local allergens than control children (OR 0.64; 95% CI = 0.44-0.94). Specific IgE for dust mites and cockroach was elevated (52%) in both case and control children. However, specific IgE to peppertree was higher in the case children (OR 2.18; 95% CI = 1.17-4.07). All identified differences were particularly marked for children with severe RSV.
Severe RSV infection in infancy was associated with decreased lung function in preschool age in Guinea-Bissau. Children with severe RSV disease had more long-term health problems than children with less severe disease.
本研究旨在根据初始感染的严重程度，调查低收入国家呼吸道合胞病毒（RSV）阳性急性下呼吸道感染（ALRI）的长期后果。
本研究为1:1匹配的病例对照研究，涉及335例RSV病例儿童和335例对照儿童。RSV ALRI患儿的平均年龄为0.9岁，随访时为6.8岁。通过抗原和IgM检测在医院和社区识别病例儿童以诊断RSV。当儿童在医院接受治疗时，定义为严重RSV感染；而当儿童在家中被诊断且未在医院接受治疗时，则认为疾病不太严重。
随访时，病例儿童的1秒用力呼气量（FEV1）和峰值流速显著降低（优势比[OR]=0.28；95%置信区间[CI]0.10 - 0.79），这种影响在严重RSV感染的儿童中尤为明显。在患有严重疾病的病例儿童中，随访时支气管炎的报告更为频繁。与对照儿童相比，对局部变应原进行皮肤点刺试验呈阳性的病例儿童较少（OR 0.64；95%CI = 0.44 - 0.94）。病例儿童和对照儿童中尘螨和蟑螂的特异性IgE均升高（52%）。然而，病例儿童中对三叶漆树的特异性IgE更高（OR 2.18；95%CI = 1.17 - 4.07）。所有已识别的差异在严重RSV感染的儿童中尤为明显。
在几内亚比绍，婴儿期严重RSV感染与学龄前儿童肺功能下降有关。患有严重RSV疾病的儿童比病情较轻的儿童有更多的长期健康问题。
