Hornsleth A, Klug B, Nir M, Johansen J, Hansen K S, Christensen L S, Larsen L B
Institute of Medical Microbiology and Immunology, University of Copenhagen and Department of Clinical Microbiology, Rigshospitalet, Denmark.
Pediatr Infect Dis J. 1998 Dec;17(12):1114-21. doi: 10.1097/00006454-199812000-00003.
Investigations concerning the severity of respiratory syncytial virus (RSV) disease as related to (1) RSV type and genotype determined respectively by PCR and restriction enzyme analysis and (2) interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) values in samples of nasopharyngeal secretion (NPS) have not been previously reported.
We prospectively studied 105 RSV infections in the lower respiratory tract of infants and young children admitted to a pediatric department in Copenhagen during three winter seasons, 1993, 1994 and 1995. RSV strains were typed and genotyped, respectively, by PCR and nucleic acid restriction analysis and correlated to the severity of the disease. The ratio IL-6:TNF-alpha, determined from IL-6- and TNF-alpha values in samples of NPS, was related to the severity of the disease. Concentrations of IL-6 and of TNF-alpha were determined in serum samples taken during 5 weeks after the onset of illness.
Type B infections produced more severe disease than did type A infections, as assessed on the length of the hospital stay, use of respiratory support and the presence of an infiltrate on a chest radiograph. This difference was age-related. It was observed in infants 0 to 5 months old, but not in older age groups. Type B genotype B1122 produced more severe disease than type A genotype A2311 in infants 0 to 11 months old. Increased serum concentrations of IL-6 and TNF-alpha were detected in samples taken 1 to 2 days after the onset of illness. Whereas TNF-alpha serum concentrations remained high, IL-6 serum concentrations decreased during the following 3 to 4 weeks. The IL-6:TNF-alpha ratio in samples of NPS was related to the severity of the disease. A high ratio was related to a low severity.
The severity of disease in patients admitted with acute RSV infections can be correlated to the RSV type as determined by PCR, to the RSV genotype as determined by nucleic acid restriction analysis and to the ratio IL-6:TNF-alpha in NPS.
关于呼吸道合胞病毒（RSV）疾病严重程度与以下因素的相关性研究尚未见报道：（1）分别通过聚合酶链反应（PCR）和限制性酶切分析确定的RSV类型和基因型；（2）鼻咽分泌物（NPS）样本中的白细胞介素6（IL-6）和肿瘤坏死因子α（TNF-α）值。
我们对1993年、1994年和1995年三个冬季入住哥本哈根一家儿科病房的婴幼儿下呼吸道RSV感染进行了前瞻性研究。通过PCR和核酸限制性分析分别对RSV毒株进行分型和基因分型，并与疾病严重程度相关联。根据NPS样本中的IL-6和TNF-α值确定的IL-6:TNF-α比值与疾病严重程度相关。在发病后5周内采集的血清样本中测定IL-6和TNF-α的浓度。
根据住院时间、呼吸支持的使用情况以及胸部X线片上有无浸润影评估，B型感染比A型感染导致的疾病更严重。这种差异与年龄有关。在0至5个月大的婴儿中观察到了这种差异，但在年龄较大的组中未观察到。在0至11个月大的婴儿中，B型基因型B1122比A型基因型A2311导致的疾病更严重。在发病后1至2天采集的样本中检测到IL-6和TNF-α的血清浓度升高。虽然TNF-α血清浓度在接下来的3至4周内一直保持较高水平，但IL-6血清浓度下降。NPS样本中的IL-6:TNF-α比值与疾病严重程度相关。高比值与低严重程度相关。
急性RSV感染患者的疾病严重程度可与通过PCR确定的RSV类型、通过核酸限制性分析确定的RSV基因型以及NPS中的IL-6:TNF-α比值相关联。
