Bergsträsser E, Zbinden R, Minder C, Gnehm H E
Kinderklinik, Kantonsspital Aarau, Schweiz.
Klin Padiatr. 1998 Nov-Dec;210(6):418-21. doi: 10.1055/s-2008-1043915.
Since it is possible to identify the subgroups of RSV, A-subtype and B-subtype, there are findings indicating that the subtype may influence severity of RSV infection. Our study was designed to assess the hypothesis that A-subtype infections were more severe than B-subtype infections among hospitalized children.
All medical records of patients hospitalized with RSV infection between March 1990 and March 1993 were reviewed. A total of 107 children with proven RSV infection were identified.
Nasal waste specimens for culture were obtained from infants with suspected RSV infection. Subtype determination was done on frozen virus cultures. The following risk factors were defined: age < or = 3 months, weight < 5 kg, prematurity and underlying cardiac or respiratory disease and immune deficiency. To analyse the relationship between risk factors, subtype and severity a multivariate analysis was performed. Severity was measured by clinical observations as following: pH, PCO2, SaO2, oxygen supplementation, history of apnea and length of hospital stay.
Of the enrolled patients 11 had underlying disease and 17 were premature. The age range was 1 week to 4.2 years, median 3.5 months. 46 children were younger than 3 months, 33 had a weight of less than 5 kg. The isolates of 84 children were typeable: 63 isolates were subtype A and 21 subtype B. Underlying disease and prematurity were associated with SaO2 < 87% (p = 0.003) and oxygen supplementation (p = 0.017). A weight of less than 5 kg was correlated with a PCO2 > or = 50 mmHg. The RSV subtype was not significantly correlated with severity.
RSV infection even in very young children is predominantly influenced by underlying disease, prematurity and weight. The RSV subtype was no independent risk factor for an increased morbidity in this retrospective study. Therefore, in our opinion, RSV subtype is less meaningful to predict the severity of RSV infection than known risk factors.
由于可以识别呼吸道合胞病毒（RSV）的亚组，即A亚型和B亚型，有研究结果表明该亚型可能会影响RSV感染的严重程度。我们的研究旨在评估以下假设：在住院儿童中，A亚型感染比B亚型感染更严重。
回顾了1990年3月至1993年3月期间因RSV感染住院的所有患者的病历。共确定了107例经证实的RSV感染儿童。
从疑似RSV感染的婴儿中获取鼻腔分泌物标本进行培养。在冷冻病毒培养物上进行亚型测定。定义了以下危险因素：年龄≤3个月、体重<5 kg、早产以及潜在的心脏或呼吸系统疾病和免疫缺陷。为了分析危险因素、亚型与严重程度之间的关系，进行了多变量分析。严重程度通过以下临床观察指标衡量：pH值、二氧化碳分压（PCO2）、血氧饱和度（SaO2）、吸氧情况、呼吸暂停病史和住院时间。
入组患者中，11例有潜在疾病，17例为早产儿。年龄范围为1周至4.2岁，中位数为3.5个月。46名儿童年龄小于3个月，33名体重小于5 kg。84名儿童的分离株可分型：63株为A亚型，21株为B亚型。潜在疾病和早产与血氧饱和度<87%（p = 0.003）和吸氧情况（p = 0.017）相关。体重小于5 kg与二氧化碳分压≥50 mmHg相关。RSV亚型与严重程度无显著相关性。
即使在非常年幼的儿童中，RSV感染主要受潜在疾病、早产和体重的影响。在这项回顾性研究中，RSV亚型不是发病率增加的独立危险因素。因此，我们认为，与已知危险因素相比，RSV亚型对预测RSV感染严重程度的意义较小。
