Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Johannesburg, South Africa.
BMJ Open Respir Res. 2023 May;10(1). doi: 10.1136/bmjresp-2023-001618.
Respiratory syncytial virus (RSV) is the most common cause of hospitalisation for lower respiratory tract infection (LRTI) in children. RSV LRTI during early childhood may increase susceptibility to recurrent wheezing and asthma.
The aim of this study was to describe the pulmonary sequelae at 1 and 2 years of age following RSV LRTI hospitalisation during the first year of life in term infants.
A longitudinal case-control study was undertaken from April 2016 to December 2019. Cases constituted children hospitalised with PCR-confirmed RSV LRTI during infancy and controls were children not previously hospitalised with LRTI. A questionnaire detailing environmental and medical history, as well as a modified International Study of Asthma and Allergies (ISAAC) questionnaire, was administered, and pulmonary function testing, including oscillometry, tidal breath flow-volume loops and multiple breath wash-out, was performed, at one and two years of age.
One (n=308) and two-year-old (n=214) cases were more likely than one (n=292) and two-year-old (n=209) controls to have experienced clinical pulmonary symptoms, including wheezing ((55% vs 24%; p<0.001) and (61% vs 16%; p<0.001)), received treatment for wheezing ((17 vs 8%; p<0.001) and (51 vs 6%; p<0.001)) and had any admissions for wheezing ((31 vs 6%; p<0.001) and (46 vs 1.4%; p<0.001)) or any LRTI ((24 vs 2%; p<0.001) and (32 vs 1.4%; p<0.001)), after the initial RSV hospitalisation. RSV LRTI during infancy was associated with an increase in airway resistance by two years (22.46 vs 20.76 hPa.s.l (p=0.022)), along with a decrease in compliance at both one (-4.61 vs -3.09 hPa.s/l (p<0.001)) and two years (-0.99 vs 0.33 hPa.s/l (p<0.001)). There was an increased work of breathing at one year, but this was no longer present at two years.
RSV LRTI during infancy in cases was associated with more clinical and pulmonary function sequelae through to two years of age.
呼吸道合胞病毒（RSV）是导致儿童下呼吸道感染（LRTI）住院的最常见原因。婴幼儿时期 RSV 引起的 LRTI 可能会增加反复喘息和哮喘的易感性。
本研究旨在描述婴儿期 RSV LRTI 住院后 1 年和 2 年时，足月婴儿的肺部后遗症。
这是一项从 2016 年 4 月至 2019 年 12 月进行的纵向病例对照研究。病例组由婴儿期经 PCR 确诊 RSV LRTI 住院的患儿组成，对照组为既往无 LRTI 住院史的患儿。在 1 岁和 2 岁时，对所有患儿进行详细的环境和病史问卷调查，以及改良的国际哮喘和过敏研究（ISAAC）问卷调查，并进行肺功能检测，包括振荡法、潮气呼吸流量-容积环和多次呼吸冲洗。
1 岁（n=308）和 2 岁（n=214）的病例组比 1 岁（n=292）和 2 岁（n=209）的对照组更有可能出现临床肺部症状，包括喘息（（55%比 24%；p<0.001）和（61%比 16%；p<0.001））、接受喘息治疗（（17 比 8%；p<0.001）和（51 比 6%；p<0.001））以及任何喘息住院（（31 比 6%；p<0.001）和（46 比 1.4%；p<0.001））或任何 LRTI（（24 比 2%；p<0.001）和（32 比 1.4%；p<0.001））。与初次 RSV 住院相比，婴儿期 RSV LRTI 与两岁时气道阻力增加（22.46 比 20.76 hPa.s.l（p=0.022））以及一岁（-4.61 比-3.09 hPa.s/l（p<0.001））和两岁（-0.99 比 0.33 hPa.s/l（p<0.001））时肺顺应性降低有关。一岁时呼吸做功增加，但两岁时不再增加。
病例组婴儿期 RSV LRTI 与 2 岁时更多的临床和肺功能后遗症有关。
