Buttarelli Luca, Caselli Elisa, Gerevini Sofia, Leuratti Pietro, Gambadauro Antonella, Manti Sara, Esposito Susanna
Pediatric Clinic, Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy.
Pediatric Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, 98124 Messina, Italy.
Viruses. 2025 Jul 31;17(8):1073. doi: 10.3390/v17081073.
Respiratory syncytial virus (RSV) is a major cause of acute lower respiratory infections (ALRIs) in young children, especially bronchiolitis, with significant global health and economic impact. Increasing evidence links early-life RSV infection to long-term respiratory complications, notably recurrent wheezing and asthma. This narrative review examines these associations, emphasizing predictive factors and emerging biomarkers for risk stratification. Early RSV infection can trigger persistent airway inflammation and immune dysregulation, increasing the likelihood of chronic respiratory outcomes. Risk factors include severity of the initial infection, age at exposure, genetic susceptibility, prematurity, air pollution, and tobacco smoke. Biomarkers such as cytokines and chemokines are showing promise in identifying children at higher risk, potentially guiding early interventions. RSV-related bronchiolitis may also induce airway remodeling and promote Th2/Th17-skewed immune responses, mechanisms closely linked to asthma development. Advances in molecular profiling are shedding light on these pathways, suggesting novel targets for early therapeutic strategies. Furthermore, passive immunization and maternal vaccination offer promising approaches to reducing both acute and long-term RSV-related morbidity. A deeper understanding of RSV's prolonged impact is essential to develop targeted prevention, enhance risk prediction, and improve long-term respiratory health in children. Future studies should aim to validate biomarkers and refine immunoprophylactic strategies.
呼吸道合胞病毒（RSV）是幼儿急性下呼吸道感染（ALRIs）的主要病因，尤其是细支气管炎，对全球健康和经济产生重大影响。越来越多的证据表明，早期RSV感染与长期呼吸道并发症有关，特别是复发性喘息和哮喘。这篇叙述性综述探讨了这些关联，重点关注预测因素和用于风险分层的新兴生物标志物。早期RSV感染可引发持续性气道炎症和免疫失调，增加慢性呼吸道疾病发生的可能性。风险因素包括初始感染的严重程度、接触时的年龄、遗传易感性、早产、空气污染和烟草烟雾。细胞因子和趋化因子等生物标志物在识别高危儿童方面显示出前景，可能指导早期干预。RSV相关的细支气管炎还可能诱导气道重塑并促进Th2/Th17偏向的免疫反应，这些机制与哮喘发展密切相关。分子谱分析的进展正在揭示这些途径，为早期治疗策略提供新的靶点。此外，被动免疫和母体疫苗接种为降低急性和长期RSV相关发病率提供了有前景的方法。深入了解RSV的长期影响对于制定有针对性的预防措施、加强风险预测以及改善儿童的长期呼吸健康至关重要。未来的研究应旨在验证生物标志物并完善免疫预防策略。
