Turunen Riitta, Vuorinen Tytti, Bochkov Yury, Gern James, Jartti Tuomas
From the *Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland; †Department of Virology, University of Turku, Turku, Finland; ‡Department of Clinical Virology, Division of Microbiology and Genetics, Turku University Hospital, Turku, Finland; and §The Departments of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Pediatr Infect Dis J. 2017 Jun;36(6):539-544. doi: 10.1097/INF.0000000000001495.
Susceptibility to rhinovirus (RV)-induced early wheezing episode has been recognized as an important risk factor for asthma, but the data on different RV species are limited. Our aim was to investigate the risk for recurrences in first-time wheezing children with special focus on RV species.
First-time wheezing children (88 inpatients and 23 outpatients) were prospectively followed at 2-week, 2-month and 12-month time-points, and at first recurrence within 12 months. The respiratory virus etiology was analyzed using polymerase chain reaction. RV-positive samples were sequenced. The primary outcomes were time to a new physician-confirmed wheezing episode, time to a new RV-induced wheezing episode and time to the initiation of regular controller medication for asthma symptoms.
The median age of the children was 12 months (standard deviation, 6.0), 67% were males and 23% were sensitized. RV dominated in symptomatic and asymptomatic infections. Different RV strains were observed in 97% (67/69) of consecutive samples during follow-up. First-time wheezing children with RV-C and RV-A had an increased risk for a new physician-confirmed wheezing episode and a new RV-associated wheezing episode than non-RV group (all P < 0.05). Also, the risk for the initiation of regular controller medication was increased in RV-A and RV-C groups when compared with non-RV group (both P < 0.05).
RV causes reinfections with different strains in small children after the first wheezing episode. Both RV-A and RV-C affected children have an increased risk for recurrence, especially RV associated, and initiation of regular controller medication than those with other viruses.
鼻病毒（RV）诱发早期喘息发作的易感性已被认为是哮喘的一个重要危险因素，但关于不同RV种类的数据有限。我们的目的是研究首次喘息儿童复发的风险，特别关注RV种类。
对首次喘息儿童（88名住院患儿和23名门诊患儿）在2周、2个月和12个月时间点进行前瞻性随访，并随访12个月内的首次复发情况。使用聚合酶链反应分析呼吸道病毒病因。对RV阳性样本进行测序。主要结局指标为新的经医生确认的喘息发作时间、新的RV诱发的喘息发作时间以及开始使用常规控制药物治疗哮喘症状的时间。
儿童的中位年龄为12个月（标准差6.0），67%为男性，23%有过敏反应。RV在有症状和无症状感染中占主导。随访期间，97%（67/69）的连续样本中观察到不同的RV毒株。与非RV组相比，感染RV-C和RV-A的首次喘息儿童出现新的经医生确认的喘息发作和新的RV相关喘息发作的风险增加（所有P<0.05）。此外，与非RV组相比，RV-A和RV-C组开始使用常规控制药物的风险也增加（均P<0.05）。
首次喘息发作后，RV会导致幼儿再次感染不同毒株。感染RV-A和RV-C的儿童复发风险增加，尤其是与RV相关的复发风险，且开始使用常规控制药物的风险高于感染其他病毒的儿童。
