Department of Molecular Medicine, University of South Florida College of Medicine, Bruce B. Downs Boulevard, Tampa, FL 33612, USA.
Immunol Allergy Clin North Am. 2010 Nov;30(4):453-80, v. doi: 10.1016/j.iac.2010.09.008.
There has been significant progress in our knowledge about the relationship between infectious disease and the immune system in relation to asthma, but many unanswered questions still remain. Respiratory tract infections such as those caused by respiratory syncytial virus and rhinovirus during the first 2 years of life are still clearly associated with later wheezing and asthma, but the mechanism has not been completely worked out. Is there an "infectious march" triggered by infection in infancy that progresses to disease pathology or are infants who contract respiratory infections predisposed to developing asthma? This review focuses on the common themes in the interaction between microbes and the immune system, and presents a critical appraisal of the evidence to date. The various mechanisms whereby microbes alter the immune response and how this might influence asthma are discussed along with new and promising clinical practices for prevention and therapy. Recent advances in using sensitive polymerase chain reaction detection methods have allowed more rigorous testing of the causality hypothesis of virus infection leading to asthma, but the evidence is still equivocal. Various exceptions and inconsistencies in the clinical trials are discussed in light of new guidelines for subject inclusion/exclusion in hopes of providing some standardization. Despite past failures in vaccination and disappointing results of some clinical trials, the new strategies for prophylaxis including RNA interference and targeted delivery of microbicides offer a large dose of hope to a world suffering from an increasing incidence of asthma as well as a huge burden of health care cost and loss of quality of life.
关于呼吸道感染与哮喘之间的关系，我们的知识已经取得了重大进展，但仍有许多悬而未决的问题。在生命的头 2 年中，呼吸道合胞病毒和鼻病毒等呼吸道感染仍然与后来的喘息和哮喘明显相关，但机制尚未完全阐明。是否存在由婴儿期感染引发的“感染进程”导致疾病病理，还是感染呼吸道的婴儿更容易患上哮喘？这篇综述侧重于微生物与免疫系统相互作用的共同主题，并对迄今为止的证据进行了批判性评估。本文讨论了微生物改变免疫反应的各种机制，以及这如何影响哮喘，同时还讨论了新的有前途的预防和治疗临床实践。使用敏感聚合酶链反应检测方法的最新进展使得更严格地测试病毒感染导致哮喘的因果关系假说成为可能，但证据仍然存在争议。根据新的纳入/排除标准，讨论了临床试验中的各种例外和不一致之处，以期提供一些标准化。尽管过去在疫苗接种方面失败了，并且一些临床试验的结果令人失望，但包括 RNA 干扰和微生物靶向递送来预防的新策略为全世界越来越多的哮喘发病率以及医疗保健成本和生活质量下降的巨大负担提供了一线希望。
