Department of Pediatrics, Hospital Universitari Sant Joan de Déu, Barcelona, Spain.
Pediatr Pulmonol. 2013 May;48(5):456-63. doi: 10.1002/ppul.22633. Epub 2012 Sep 4.
The role of respiratory viruses in the pathogenesis of bronchiolitis was re-evaluated with the use of molecular methods such as PCR for virus detection. Whether specific viruses or the classical clinical risk factors are more important in determining severe bronchiolitis is not well established.
To analyze the specific viruses and clinical variables that can predict severe bronchiolitis at admission.
Nasopharyngeal aspirates were prospectively collected from 484 children <12 months admitted to the pediatrics ward or PICU at Universitary Hospital Sant Joan de Déu (Barcelona, Spain) for bronchiolitis from October 2007 to October 2008. Clinical and demographic data were collected. Sixteen respiratory viruses were studied using PCR. Severity was assessed with a bronchiolitis clinical score (BCS).
Four hundred ten infants that tested positive for respiratory viruses were analyzed. Mixed viral infections did not increase the severity of the disease. Rhinovirus was associated with severe BCS in univariate analysis (P = 0.041), but in the multivariate logistic regression including viruses and clinical data only bronchopulmonary dysplasia (OR 7.2; 95% CI 1.2-43.3), congenital heart disease (OR 4.7; 95% CI 1.1-19.9), prematurity (OR 2.6; 95% CI 1.3-5.1), and fever (OR 1.8, 95% CI 1.1-3.1) showed statistical significance for predicting severe BCS.
Classical clinical risk factors have more weight in predicting a severe BCS in infants with acute bronchiolitis than the involved viruses.
使用聚合酶链反应（PCR）等分子方法检测病毒，重新评估了呼吸道病毒在毛细支气管炎发病机制中的作用。特定病毒或经典临床危险因素在确定严重毛细支气管炎方面的作用尚不清楚。
分析可预测入院时严重毛细支气管炎的特定病毒和临床变量。
2007 年 10 月至 2008 年 10 月，从西班牙巴塞罗那 Sant Joan de Déu 大学医院儿科病房或 PICU 入院的 484 名<12 个月的毛细支气管炎患儿前瞻性采集鼻咽抽吸物。收集临床和人口统计学数据。使用 PCR 研究了 16 种呼吸道病毒。使用毛细支气管炎临床评分（BCS）评估严重程度。
分析了 410 例检测出呼吸道病毒呈阳性的婴儿。混合病毒感染并未增加疾病的严重程度。在单变量分析中，鼻病毒与严重 BCS 相关（P=0.041），但在包括病毒和临床数据的多变量逻辑回归中，只有支气管肺发育不良（OR 7.2；95%CI 1.2-43.3）、先天性心脏病（OR 4.7；95%CI 1.1-19.9）、早产（OR 2.6；95%CI 1.3-5.1）和发热（OR 1.8，95%CI 1.1-3.1）对预测严重 BCS 具有统计学意义。
在患有急性毛细支气管炎的婴儿中，经典临床危险因素对预测严重 BCS 的影响大于相关病毒。
