Hemming V G, Prince G A, Groothuis J R, Siber G R
Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814.
Clin Microbiol Rev. 1995 Jan;8(1):22-33. doi: 10.1128/CMR.8.1.22.
Respiratory syncytial virus (RSV) is an important community and nosocomial respiratory pathogen for infants and young children. RSV causes especially severe disease in the prematurely born or those with chronic cardiopulmonary diseases. Elderly persons and those with T-cell deficiencies, such as bone marrow transplant recipients, are also at high risk for serious lower respiratory tract infections. To date, prevention of RSV infections by vaccination has proven elusive and no preventive drugs exist. Studies in animals and humans have shown that the lower respiratory tract can be protected from RSV infection by sufficient circulating RSV neutralizing antibody levels. Recently, an RSV hyperimmune immune globulin (RSVIG) was developed and tested for the prevention of RSV infections or reduction of disease severity. Passive immunization of high-risk children with RSVIG during the respiratory disease season effected significant reductions in RSV infections, hospitalizations, days of hospitalization, intensive care unit admissions, days in the intensive care unit, and ribavirin use. Studies in cotton rats and owl monkeys show that RSV infections can also be treated with inhalation of immune globulin at doses substantially smaller than required for parenteral treatment. Therapeutic trials of parenteral RSVIG have been completed and are pending analysis. The use of polyclonal, hyperimmune globulins and perhaps human monoclonal antibodies provides an additional approach to the prevention and perhaps the treatment of certain viral lower respiratory tract infections such as those caused by RSV.
呼吸道合胞病毒（RSV）是婴幼儿社区获得性和医院获得性呼吸道感染的重要病原体。RSV在早产儿或患有慢性心肺疾病的儿童中可引发特别严重的疾病。老年人以及患有T细胞缺陷的人群，如骨髓移植受者，也面临严重下呼吸道感染的高风险。迄今为止，通过疫苗预防RSV感染尚未成功，且尚无预防性药物。动物和人体研究表明，足够的循环RSV中和抗体水平可保护下呼吸道免受RSV感染。最近，一种RSV高效免疫球蛋白（RSVIG）被研发出来并用于预防RSV感染或减轻疾病严重程度。在呼吸道疾病季节，对高危儿童进行RSVIG被动免疫可显著降低RSV感染率、住院率、住院天数、重症监护病房入住率、在重症监护病房的天数以及利巴韦林的使用。对棉鼠和夜猴的研究表明，吸入免疫球蛋白治疗RSV感染所需剂量远低于肠胃外给药，且同样有效。肠胃外RSVIG的治疗试验已经完成，正在等待分析。使用多克隆高效免疫球蛋白以及可能的人单克隆抗体为预防甚至治疗某些病毒性下呼吸道感染（如RSV引起的感染）提供了另一种方法。
