Welliver R C
Department of Pediatrics, Children's Hospital of Buffalo, NY, USA.
Semin Perinatol. 1998 Feb;22(1):87-95. doi: 10.1016/s0146-0005(98)80010-4.
Respiratory syncytial virus (RSV) infection is particularly severe in infants with bronchopulmonary dysplasia (BPD) and in premature infants without BPD. Attempts to develop a vaccine against RSV have been unsuccessful. Passive immunoprophylaxis of premature infants with or without BPD using a hyperimmune human globulin against RSV (RSVIg) decreases the severity of RSV infection such that the rate of hospitalization following infection is reduced by 40%. The severity of illness among hospitalized infants is also reduced. To avoid the difficulties associated with intravenous infusion of immunoglobulins, monoclonal IgG antibodies against the fusion protein of RSV have been developed. In one trial, the antibodies were ineffective, although subsequent trials using higher doses of the antibody show more promising results. Studies of IgA monoclonal antibodies directed against RSV, which are administered in the form of nose drops, are also in progress. None of these preparations appear to be effective in the treatment of established RSV infection. Each of the preparations appeared to be safe, with one exception. Infants with cyanotic heart disease who received RSVIg had an increased risk of surgical complications, perhaps related to increases in serum viscosity as a result of receiving the hyperimmunoglobulin monthly in doses of 750 mg/kg. While definitive cost/benefit analyses are pending, RSVIg may be useful in infants and children with BPD who have current or recent oxygen requirements, as well as in certain premature infants without BPD. Recommendations on the use of RSVIg are provided.
呼吸道合胞病毒（RSV）感染在患有支气管肺发育不良（BPD）的婴儿以及未患BPD的早产儿中尤为严重。研发针对RSV的疫苗的尝试一直未成功。使用抗RSV的高效价人免疫球蛋白（RSVIg）对患有或未患BPD的早产儿进行被动免疫预防，可降低RSV感染的严重程度，使感染后住院率降低40%。住院婴儿的疾病严重程度也有所降低。为避免静脉输注免疫球蛋白带来的困难，已研发出针对RSV融合蛋白的单克隆IgG抗体。在一项试验中，这些抗体无效，不过随后使用更高剂量抗体的试验显示出更有希望的结果。针对RSV的IgA单克隆抗体以滴鼻剂形式给药的研究也在进行中。这些制剂似乎都对已确诊的RSV感染无效。除了一个例外，每种制剂似乎都是安全的。患有青紫型心脏病的婴儿接受RSVIg后手术并发症风险增加，这可能与每月接受750mg/kg剂量的高效价免疫球蛋白导致血清粘度增加有关。虽然最终的成本效益分析尚未完成，但RSVIg可能对当前或近期有吸氧需求的患BPD的婴儿和儿童以及某些未患BPD的早产儿有用。文中提供了关于RSVIg使用的建议。
