The Cleveland Clinic Pediatric Institute and Children's Hospital, Cleveland, Ohio 44159, USA.
Curr Opin Pediatr. 2013 Jun;25(3):344-9. doi: 10.1097/MOP.0b013e328360bd2e.
Respiratory syncytial virus (RSV) is the most common respiratory pathogen in infants and young children worldwide. Furthermore, epidemiological evidence has been accumulating that RSV lower respiratory tract infection in infants may be linked to subsequent development of recurrent wheezing and asthma in childhood. This article reviews the epidemiological evidence linking RSV and asthma and some new hypotheses of the cellular and molecular mechanisms of postviral airway inflammation and hyperreactivity that have been proposed to explain the epidemiological link.
New epidemiological studies have suggested that viral pathogens other than RSV, especially human rhinoviruses (HRV), may play an important role in the inception of atopic asthma. Also, recent experimental evidence is challenging the widely accepted axiom that RSV is cleared from immunocompetent hosts within weeks from the onset of the infection. In particular, bone marrow stromal cells may be a frequent target of human RSV infection, develop structural and functional changes when infected, participate actively in the pathogenesis of the acute disease, and harbor the virus chronically, allowing persistence of the infection.
RSV - and possibly other common respiratory pathogens - play an important role not only in the exacerbation, but also in the inception of asthma. The latter effect may involve the persistence of latent virus in extrapulmonary tissues, similar to what has been recently found for some bacterial species. The most immediate consequence of these discoveries is that future prophylactic and therapeutic strategies for common infections caused by viral or bacterial pathogens may have to address the coverage of remote sites of latent persistence or replication, in order to avoid chronic sequelae-recurrent wheezing and asthma.
呼吸道合胞病毒（RSV）是全球婴幼儿最常见的呼吸道病原体。此外，越来越多的流行病学证据表明，婴幼儿 RSV 下呼吸道感染可能与随后儿童期反复喘息和哮喘的发展有关。本文综述了 RSV 与哮喘相关的流行病学证据，以及一些新的假设，即病毒后气道炎症和高反应性的细胞和分子机制，这些假设被提出以解释这种流行病学联系。
新的流行病学研究表明，除 RSV 以外的其他病毒病原体，特别是人类鼻病毒（HRV），可能在特应性哮喘的发生中起重要作用。此外，最近的实验证据对 RSV 在感染后数周内从免疫功能正常的宿主中清除的这一广泛接受的公理提出了挑战。特别是骨髓基质细胞可能是人类 RSV 感染的常见靶细胞，感染后会发生结构和功能改变，积极参与急性疾病的发病机制，并在慢性感染时携带病毒，从而使感染持续存在。
RSV 及可能的其他常见呼吸道病原体，不仅在哮喘恶化中，而且在哮喘发生中都起着重要作用。后一种作用可能涉及潜伏病毒在肺外组织中的持续存在，类似于最近在某些细菌种中发现的情况。这些发现最直接的结果是，未来针对病毒或细菌病原体引起的常见感染的预防和治疗策略，可能必须解决潜伏持续或复制的远程部位的覆盖问题，以避免慢性后遗症-反复喘息和哮喘。
