West Middlesex University Hospital, Chelsea and Westminster Foundation Trust, London, UK.
Centre for Paediatrics and Child Health, Imperial College, London, London, UK.
Pediatr Allergy Immunol. 2022 Mar;33(3):e13741. doi: 10.1111/pai.13741.
Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis. RSV-induced bronchiolitis has been associated with preschool wheeze and asthma in cohort studies where the comparison groups consist of healthy infants. However, recent studies identify rhinovirus (RV)-induced bronchiolitis as a potentially stronger risk factor for recurrent wheeze and asthma.
This systematic review and meta-analysis aimed to compare the associations of RSV- and RV-induced bronchiolitis with the development of preschool wheeze and childhood asthma.
We performed a systematic search of the published literature in five databases by using a MeSH term-based algorithm. Cohort studies that enrolled infants with bronchiolitis were included. The primary outcomes were recurrent wheeze and asthma diagnosis. Wald risk ratios and odds ratios (ORs) were estimated, along with their 95% confidence intervals (CIs). Individual and summary ORs were visualized with forest plots.
There were 38 studies included in the meta-analysis. Meta-analysis of eight studies that had data on the association between infant bronchiolitis and recurrent wheeze showed that the RV-bronchiolitis group were more likely to develop recurrent wheeze than the RSV-bronchiolitis group (OR 4.11; 95% CI 2.24-7.56). Similarly, meta-analysis of the nine studies that had data on asthma development showed that the RV-bronchiolitis group were more likely to develop asthma (OR 2.72; 95% CI 1.48-4.99).
This is the first meta-analysis that directly compares between-virus differences in the magnitude of virus-recurrent wheeze and virus-childhood asthma outcomes. RV-induced bronchiolitis was more strongly associated with the risk of developing wheeze and childhood asthma.
呼吸道合胞病毒（RSV）是毛细支气管炎最常见的病因。在队列研究中，与健康婴儿相比，RSV 引起的毛细支气管炎与学龄前喘息和哮喘有关。然而，最近的研究表明，鼻病毒（RV）引起的毛细支气管炎是反复喘息和哮喘的潜在更强危险因素。
本系统评价和荟萃分析旨在比较 RSV 和 RV 引起的毛细支气管炎与学龄前喘息和儿童哮喘发展的关联。
我们使用基于 MeSH 术语的算法在五个数据库中进行了已发表文献的系统搜索。纳入了患有毛细支气管炎的婴儿的队列研究。主要结局是反复喘息和哮喘诊断。估计了 Wald 风险比和比值比（OR）及其 95%置信区间（CI）。个体和汇总 OR 用森林图可视化。
共有 38 项研究纳入荟萃分析。对 8 项研究数据进行荟萃分析，这些研究数据显示婴儿毛细支气管炎与反复喘息之间的关联，结果表明 RV 毛细支气管炎组比 RSV 毛细支气管炎组更有可能发展为反复喘息（OR 4.11；95%CI 2.24-7.56）。同样，对 9 项研究数据进行荟萃分析，这些研究数据显示哮喘的发展，结果表明 RV 毛细支气管炎组更有可能发展为哮喘（OR 2.72；95%CI 1.48-4.99）。
这是第一项直接比较病毒间喘息和病毒儿童哮喘结局严重程度差异的荟萃分析。RV 引起的毛细支气管炎与喘息和儿童哮喘发展的风险相关性更强。
