Simoes Eric A F, Groothuis Jessie R, Carbonell-Estrany Xavier, Rieger Christian H L, Mitchell Ian, Fredrick Linda M, Kimpen Jan L L
Department of Pediatric Infectious Diseases, University of Colorado School of Medicine and The Children's Hospital, Denver, CO 80218, USA.
J Pediatr. 2007 Jul;151(1):34-42, 42.e1. doi: 10.1016/j.jpeds.2007.02.032.
Children who experience respiratory syncytial virus (RSV) lower respiratory tract infections (LRTIs) early in life have high rates of subsequent recurrent wheezing. Palivizumab, an anti-RSV monoclonal antibody, has 78% to 80% efficacy in preventing RSV hospitalization in premature infants without chronic lung disease. We hypothesized that palivizumab, by ameliorating or preventing early RSV LRTI in preterm infants, might decrease later recurrent wheezing.
A cohort of preterm infants who had received palivizumab and were not hospitalized for RSV (n = 191) or who never received palivizumab (n = 230; 76 who were hospitalized for RSV and 154 who were not), were prospectively followed for 24 months beginning at a mean age of 19 months. The subjects were assessed for recurrent wheezing by caretaker or physician report.
The incidences of recurrent wheezing and physician-diagnosed recurrent wheezing were significantly lower in the 191 palivizumab-treated subjects (13% and 8%, respectively) compared with all 230 untreated subjects (26%, P = .001 and 16%, P = .011, respectively) and with the 154 patients in the subgroup not hospitalized for RSV LRTI (23%, P = .022 and 16%, P = .027, respectively). The effect of palivizumab treatment remained significant after adjustment for potential confounding variables.
Our study suggests that preventing RSV LRTI with palivizumab may reduce subsequent recurrent wheezing in premature infants.
在生命早期经历呼吸道合胞病毒（RSV）下呼吸道感染（LRTI）的儿童随后反复喘息的发生率很高。帕利珠单抗，一种抗RSV单克隆抗体，在预防无慢性肺病的早产儿RSV住院方面有78%至80%的疗效。我们假设，帕利珠单抗通过改善或预防早产儿早期RSV LRTI，可能会降低后期反复喘息的发生率。
一组接受帕利珠单抗且未因RSV住院的早产儿（n = 191）或从未接受帕利珠单抗的早产儿（n = 230；76例因RSV住院，154例未住院），从平均19个月龄开始进行前瞻性随访24个月。通过照顾者或医生报告评估受试者的反复喘息情况。
与所有230例未治疗的受试者（分别为26%，P = .001和16%，P = .011）以及未因RSV LRTI住院的亚组中的154例患者（分别为23%，P = .022和16%，P = .027）相比，191例接受帕利珠单抗治疗的受试者中反复喘息和医生诊断的反复喘息的发生率显著更低（分别为13%和8%）。在对潜在混杂变量进行调整后，帕利珠单抗治疗的效果仍然显著。
我们的研究表明，用帕利珠单抗预防RSV LRTI可能会降低早产儿随后反复喘息的发生率。
