Arimura Ken, Kan-O Keiko, Sato Yasuto, Kikuchi Ken, Miura Hitomi, Sato Asako, Kondo Mitsuko, Tagaya Etsuko
Department of Respiratory Medicine, Tokyo Women's Medical University, Tokyo, Japan.
National Institute of Public Health, Center for Health Informatics Policy, Saitama, Japan.
Lung. 2025 Sep 3;203(1):91. doi: 10.1007/s00408-025-00847-x.
Respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) are common viral etiologies of respiratory infections. Although co-infection with other respiratory pathogens is frequently observed, its clinical significance remains unclear.
We retrospectively analyzed 57,746 patients who underwent FILMARRAY®, a comprehensive multiplex polymerase chain reaction testing, between November 2020 and March 2023. Clinical features were compared between single infection and co-infection involving RSV or hMPV using χ or Fisher's exact tests. Multiple logistic regression was performed to identify associations with bronchial asthma (BA) exacerbation, adjusting for age, sex, testing period, and RSV co-infection.
Among RSV-positive patients, co-infection was associated with higher prevalence of BA history, wheeze, BA exacerbation, combined BA history and exacerbation, systemic steroid use, and age under 6 years compared to that with single infection. RSV co-infection with coronavirus, parainfluenza virus, adenovirus, and rhinovirus/enterovirus was particularly associated with BA exacerbation. Age under 6 years and RSV co-infection were identified as independent risk factors for BA exacerbation using multiple logistic regression. In contrast, no associations were observed in the hMPV co-infection.
RSV co-infection with other respiratory viruses increases the risk of BA exacerbation, especially in age under 6 years patients. Given the proven efficacy of RSV vaccine for adults and monoclonal antibody for high-risk children in preventing RSV-related lower respiratory tract disease, RSV-targeted prevention strategies for younger children appear effective in reducing respiratory disease burden.
呼吸道合胞病毒（RSV）和人偏肺病毒（hMPV）是呼吸道感染常见的病毒病因。尽管经常观察到与其他呼吸道病原体的合并感染，但其临床意义仍不明确。
我们回顾性分析了2020年11月至2023年3月期间接受FILMARRAY®（一种全面的多重聚合酶链反应检测）的57746例患者。使用χ检验或Fisher精确检验比较了涉及RSV或hMPV的单一感染和合并感染之间的临床特征。进行多因素逻辑回归分析以确定与支气管哮喘（BA）加重的关联，并对年龄、性别、检测时间和RSV合并感染进行了校正。
在RSV阳性患者中，与单一感染相比，合并感染与BA病史、喘息、BA加重、BA病史合并加重、全身使用类固醇以及6岁以下年龄的患病率较高有关。RSV与冠状病毒、副流感病毒、腺病毒和鼻病毒/肠道病毒的合并感染尤其与BA加重有关。使用多因素逻辑回归分析确定6岁以下年龄和RSV合并感染是BA加重的独立危险因素。相比之下，在hMPV合并感染中未观察到关联。
RSV与其他呼吸道病毒的合并感染增加了BA加重的风险，尤其是在6岁以下的患者中。鉴于RSV疫苗对成人和高危儿童单克隆抗体在预防RSV相关下呼吸道疾病方面已证实的疗效，针对年幼儿童的RSV靶向预防策略似乎可有效减轻呼吸道疾病负担。
