Hasegawa Kohei, Jartti Tuomas, Mansbach Jonathan M, Laham Federico R, Jewell Alan M, Espinola Janice A, Piedra Pedro A, Camargo Carlos A
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School.
Department of Pediatrics, Turku University Hospital, Finland.
J Infect Dis. 2015 May 15;211(10):1550-9. doi: 10.1093/infdis/jiu658. Epub 2014 Nov 25.
We investigated whether children with a higher respiratory syncytial virus (RSV) genomic load are at a higher risk of more-severe bronchiolitis.
Two multicenter prospective cohort studies in the United States and Finland used the same protocol to enroll children aged <2 years hospitalized for bronchiolitis and collect nasopharyngeal aspirates. By using real-time polymerase chain reaction analysis, patients were classified into 3 genomic load status groups: low, intermediate, and high. Outcome measures were a length of hospital stay (LOS) of ≥3 days and intensive care use, defined as admission to the intensive care unit or use of mechanical ventilation.
Of 2615 enrolled children, 1764 (67%) had RSV bronchiolitis. Children with a low genomic load had a higher unadjusted risk of having a length of stay of ≥3 days (52%), compared with children with intermediate and those with high genomic loads (42% and 51%, respectively). In a multivariable model, the risk of having a length of stay of ≥3 days remained significantly higher in the groups with intermediate (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.20-1.69) and high (OR, 1.58; 95% CI, 1.29-1.94) genomic loads. Similarly, children with a high genomic load had a higher risk of intensive care use (20%, compared with 15% and 16% in the groups with low and intermediate genomic loads, respectively). In a multivariable model, the risk remained significantly higher in the group with a high genomic load (OR, 1.43; 95% CI, 1.03-1.99).
Children with a higher RSV genomic load had a higher risk for more-severe bronchiolitis.
我们调查了呼吸道合胞病毒（RSV）基因组载量较高的儿童是否患更严重细支气管炎的风险更高。
美国和芬兰的两项多中心前瞻性队列研究采用相同方案，纳入因细支气管炎住院的2岁以下儿童，并收集鼻咽抽吸物。通过实时聚合酶链反应分析，将患者分为3个基因组载量状态组：低、中、高。观察指标为住院时间（LOS）≥3天和重症监护使用情况，重症监护使用情况定义为入住重症监护病房或使用机械通气。
在2615名纳入研究的儿童中，1764名（67%）患有RSV细支气管炎。基因组载量低的儿童住院时间≥3天的未调整风险较高（52%），而基因组载量中等和高的儿童分别为42%和51%。在多变量模型中，基因组载量中等（比值比[OR]，1.43；95%置信区间[CI]，1.20 - 1.69）和高（OR，1.58；95%CI，1.29 - 1.94）的组中，住院时间≥3天的风险仍然显著更高。同样，基因组载量高的儿童重症监护使用风险较高（20%），而基因组载量低和中等的组分别为15%和16%。在多变量模型中，基因组载量高的组风险仍然显著更高（OR，1.43；95%CI，1.03 - 1.99）。
RSV基因组载量较高的儿童患更严重细支气管炎的风险更高。
