Chen Chien-Han, Lin Yu-Tsan, Yang Yao-Hsu, Wang Li-Chieh, Lee Jyh-Hong, Kao Chuan-Liang, Chiang Bor-Luen
Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China.
Pediatr Allergy Immunol. 2008 Mar;19(2):166-72. doi: 10.1111/j.1399-3038.2007.00610.x.
Respiratory syncytial virus (RSV) bronchiolitis in early life is a risk factor for later development of asthma and atopy. Ribavirin is the only effective drug currently available against acute RSV bronchiolitis. However, the long-term effects of ribavirin remain unclear. We investigated a cohort of children hospitalized with RSV bronchiolitis from when they were under 2 yr old until they reached a mean age of 6.2 yr. In total, we enrolled 175 children in this study. Both the group treated with ribavirin and the group not treated with ribavirin included high-risk young children with congenital heart disease or chronic lung disease. Their respective age-matched controls, that we labeled groups A and B, both without ribavirin treatment, consisted of previously healthy subjects. Wheezing was either verified by physicians or estimated by a questionnaire. Allergen sensitization was judged by serum allergen-specific IgE levels. The cumulative incidence of physician-diagnosed asthma or recurrent wheezing in the ribavirin group (15%) was significantly lower than its incidence in the non-ribavirin-treated group (34%, p = 0.049), and in the control A group (43%, p = 0.005). Allergen sensitization was also least frequent in the ribavirin group. Ribavirin therapy was an independent factor in reducing the risk of developing asthma, asthma/recurrent wheezing, and sensitization to D. pteronyssinus/D. farinae. The long-term value of ribavirin for acute RSV bronchiolitis and its underlying mechanisms deserves further research.
儿童早期的呼吸道合胞病毒（RSV）细支气管炎是日后发生哮喘和特应性疾病的一个危险因素。利巴韦林是目前唯一可有效治疗急性RSV细支气管炎的药物。然而，利巴韦林的长期影响仍不明确。我们对一组2岁以下因RSV细支气管炎住院的儿童进行了调查，随访至他们的平均年龄达到6.2岁。本研究共纳入175名儿童。接受利巴韦林治疗的组和未接受利巴韦林治疗的组均包括患有先天性心脏病或慢性肺病的高危幼儿。他们各自年龄匹配的对照组（我们标记为A组和B组）均未接受利巴韦林治疗，由既往健康的受试者组成。喘息症状由医生确诊或通过问卷评估。通过血清过敏原特异性IgE水平判断过敏原致敏情况。利巴韦林组医生诊断的哮喘或复发性喘息的累积发生率（15%）显著低于未接受利巴韦林治疗的组（34%，p = 0.049）以及对照组A组（43%，p = 0.005）。利巴韦林组的过敏原致敏情况也最少见。利巴韦林治疗是降低发生哮喘、哮喘/复发性喘息以及对屋尘螨/粉尘螨致敏风险的一个独立因素。利巴韦林对急性RSV细支气管炎的长期价值及其潜在机制值得进一步研究。
