Ochoa Sangrador C, González de Dios J
Hospital Virgen de la Concha, Zamora, España.
An Pediatr (Barc). 2010 Mar;72(3):222.e1-222.e26. doi: 10.1016/j.anpedi.2009.11.019. Epub 2010 Feb 13.
A review of the evidence on epidemiology, risk factors, etiology and clinical-etiological profile of acute bronchiolitis is presented. The frequency estimates are very heterogeneous; in the population under two years the frequency of admission for bronchiolitis is between 1 and 3.5%, primary care consultations between 4 and 20% and emergency visits between 1 and 2%. The frequency of admissions for respiratory infection by respiratory syncytial virus in the risk population is: in premature infants < or =32 weeks of gestation between 4.4 and 18%, in patients with bronchopulmonary dysplasia between 7.3 and 42%, and in infants with congenital heart disease between 1.6 and 9.8%. The main risk factors are: prematurity, chronic lung disease or bronchopulmonary dysplasia, congenital heart disease and age less than 3-6 months at onset of the epidemic. Other factors are: older siblings or day care attendance, male gender, exposure to smoking, breastfeeding for less than 1-2 months and variables associated with lower socioeconomic status. Respiratory syncytial virus is the dominant etiological agent, constituting just over half the cases (median 56%; interval 27% to 73%). Other viruses implicated, in descending order of frequency, are rhinovirus, adenovirus, metapneumovirus, influenza viruses, parainfluenza, enterovirus and bocavirus. In studies with genomic detection techniques, between 20 and 25% of cases the virus involved is not identified and between 9% and 27% of cases have viral co-infection. Although respiratory syncytial virus bronchiolitis shows more wheezing and retractions, longer duration of respiratory symptoms and oxygen therapy and are associated with lower use of antibiotics. This pattern is associated with the younger age of the patients and does not help us to predict the etiology. In general, the etiological identification is not useful for the management of patients. However, in young infants (<3 months) with febrile bronchiolitis in the hospital environment, conservative management may help these patients and avoid diagnostic and therapeutic procedures.
本文对急性细支气管炎的流行病学、危险因素、病因及临床病因学特征的证据进行了综述。发病率估计差异很大；在两岁以下人群中，细支气管炎的住院率在1%至3.5%之间，初级保健门诊就诊率在4%至20%之间，急诊就诊率在1%至2%之间。呼吸道合胞病毒引起的呼吸道感染在高危人群中的住院率为：孕周小于或等于32周的早产儿为4.4%至18%，支气管肺发育不良患者为7.3%至42%，先天性心脏病婴儿为1.6%至9.8%。主要危险因素包括：早产、慢性肺病或支气管肺发育不良、先天性心脏病以及在疫情开始时年龄小于3至6个月。其他因素有：有哥哥姐姐或参加日托、男性、接触吸烟、母乳喂养少于1至2个月以及与社会经济地位较低相关的变量。呼吸道合胞病毒是主要病原体，占病例的一半以上（中位数为56%；区间为27%至73%）。其他涉及的病毒按频率从高到低依次为鼻病毒、腺病毒、偏肺病毒、流感病毒、副流感病毒、肠道病毒和博卡病毒。在采用基因组检测技术的研究中，20%至25%的病例未识别出相关病毒，9%至27%的病例存在病毒合并感染。虽然呼吸道合胞病毒细支气管炎表现出更多的喘息和呼吸凹陷、呼吸道症状持续时间更长以及需要氧气治疗，且使用抗生素较少。这种模式与患者年龄较小有关，无助于我们预测病因。一般来说，病因鉴定对患者的管理并无用处。然而，在医院环境中，对于患有发热性细支气管炎的小婴儿（<3个月），保守治疗可能对这些患者有益，并避免诊断和治疗程序。
