Use of flow cytometry to investigate the cytokine response pattern in infants with respiratory syncytial virus infection and bronchiolitis

Objective: To investigate the cytokine response pattern (IL 4/IFN γ ) in infants with RSV infections and bronchiolitis during the acute phase. Methods: Four color flow cytometry was used to measure intracellular IL 4 and IFN γ expressions in peripheral blood CD3+ and CD8+ lymphocytes from RSV infected and bronchiolitis infants. Serum IL 4 and IFN γ levels were also determined. Results: RSV infected and bronchiolitis infants showed no statistical differences from not RSV infected or pneumonia infants and control in the frequency of IL 4 and IFN γ expressions in CD3+CD8 lymphocytes, showed no obvious Th1/Th2 imbalance, while IFN γ was expressed much more frequently in CD3+CD8+ lymphocytes. Systematically, RSV infected and bronchiolitis infants showed much lower levels of serum IL 4 and IL 4/IFN γ ratios and much higher serum IFN γ levels than control. However, there were no statistical differences in the above three indices between RSV infected and not RSV infected infants or between bronchiolitis and pneumonia infants, except that bronchiolitis infants had a higher level of serum IFN γ than pneumonia infants statistically. Conclusions: There is no type 2 cytokine response predominance in the acute phase of RSV infection and bronchiolitis. IL 4 production is suppressed and IFN γ production upregulated, the latter being most prominent in bronchiolitis infants.

Cytokine responses in infants infected with respiratory syncytial virus

Introduction: Variability in severity of Respiratory Syncytial Virus (RSV) infection is reportedly due to differences in inflammatory response. Objective: To characterize the cytokine response in RSV+ infants aged 0 - 36 months and to relate their responses to disease severity. Methods: Nasopharyngeal aspirations (NPAs) were analyzed for RSV and IL-1β, IL-2, IL-4, IL-5, IL-6, IL-10, IL-12, IL-1RA, IL-4R, IFN-γ, sTNFR1, sTNFR2, and TNF-α. Clinical data were collected from the medical records. Results: We included 331 infants of whom 214 were RSV+. In comparison to RSV- infants, they had significantly higher levels of TNF-α, IL-6, IL-1β, and IFN-γ (p α, IL-6, and IL-1β. sTNFR1/2 were significantly increased in RSV+ infants. Hospitalized patients had significantly higher levels of TNF-α, sTNFR2, and IL-10 (p < 0.05) than non-hospitalized patients. The cytokine response could not be related to disease severity. We found no evidence of a skewed Th1/Th2 immune profile. Conclusion: In acute RSV disease, infected infants’ NPAs contain a significant amount of pro-inflammatory cytokines. Whether this response is beneficial or deleterious remains unanswered. Interpersonal variations in cytokine responses might be linked to an inherited tendency to variations in disease severity.

RELATIONSHIP BETWEEN HYPERSENSITIVITY TYPE I AND WHEEZING BY RESPIRATORY SYNCYTIAL VIRUS (RSV) INFECTION

We studied the RSV specific IgE antibody, histamine and basophil from infants with RSV bronchiolitis and found during the acute phase either the titers of RSV-IgE or the concentration of histamine increased significantly, the number of basophil and basophil degranulation in the presence of RSV antigen also increased. In vitro studies revealed hypersensitivity participates in the pathogenesis of RSV bronchiolitis. We also found that infants with RSV bronchiolitis, the RSV-IgE persisted for a long time presumably this plays an important role in recurrent wheezing after RSV infection for years.

Characteristics of respiratory syncytial virus-induced bronchiolitis co-infection with Mycoplasma pneumoniae and add-on therapy with montelukast

Background:The influence of Mycoplasma pneumoniae(MP)infection on bronchiolitis remains unclear.Additionally,reports on the efficacies of leukotriene receptor antagonists in the treatment of bronchiolitis have been inconclusive.Methods:Children with respiratory syncytial virus(RSV)-induced bronchiolitis were divided into two groups:RSV+MP group and RSV group.Each group was randomly divided into two subgroups:one received routine and placebo treatment,while the other received routine and montelukast treatment for 9 months.The cumulative numbers of wheezing episodes and recurrent respiratory tract infections were recorded.Blood parameters were determined.Results:Patients in the RSV+MP group exhibited an older average age,fever,more frequent flaky and patchy shadows in chest X-rays,more frequent extrapulmonary manifestations,and longer hospital stays compared with patients in the RSV group.Additionally,higher baseline blood eosinophil counts,eosinophil cationic protein(ECP),total immunoglobulin E(IgE),interleukin(IL)-4,IL-5,IL-4/interferon-γratios,leukotriene(LT)B4,and LTC4,and lower baseline lipoxin A4(LXA4)/LTB4 ratios were observed in the RSV+MP group compared with the RSV group.Montelukast treatment decreased the cumulative numbers of recurrent wheezing episodes and recurrent respiratory tract infections at 9 and 12 months.This efficacy may be related to the montelukast-induced reductions in peripheral eosinophil counts,ECP and total IgE,as well as the montelukast-dependent recovery in T helper(Th)1/Th2 balance and LXA4/LTB4 ratios in children with bronchiolitis.Conclusions:RSV bronchiolitis with MP infection was associated with clinical and laboratory features that differed from those of RSV bronchiolitis without MP infection.Add-on therapy with montelukast for 9 months was benefi cial for children with bronchiolitis at 9 and 12 months after the initiation of treatment.

From bronchiolitis guideline to practice: A critical care perspective

Acute viral bronchiolitis is a leading cause of admission to pediatric intensive care units, but research on the care of these critically ill infants has been limited. Pathology of viral bronchiolitis revealed respiratory obstruction due to intraluminal debris and edema of the airways and vasculature. This and clinical evidence suggest that airway clearance interventions such as hypertonic saline nebulizers and pulmonary toilet devices may be of benefit, particularly in situations of atelectasis associated with bronchiolitis. Research to distinguish an underlying asthma predisposition in wheezing infants with viral bronchiolitis may one day lead to guidance on when to trial bronchodilator therapy. Considering the paucity of critical care research in pediatric viral bronchiolitis, intensive care practitioners must substantially rely on individualization of therapies based on bedside clinical assessments. However, with the introduction of new diagnostic and respiratory technologies, our ability to support critically ill infants with acute viral bronchiolitis will continue to advance.

维生素D受体基因多态性与RSV感染性毛细支气管炎的相关性研究

目的探讨维生素D受体(VDR)基因多态性与呼吸道合胞病毒(RSV)感染性毛细支气管炎的相关性。方法回顾性分析2023年1~6月佛山市妇幼保健院收治的60例RSV感染性毛细支气管炎患儿的临床资料,根据患儿临床表现分为轻症组(n=37)和重症组(n=23),另选择同期30例RSV阴性的健康体检儿童作为对照组。分别采用酶联免疫吸附法检测三组儿童的血清25-羟基维生素D[25(OH)D]、白细胞介素4(IL-4)、白细胞介素5(IL-5)水平,采用限制性片段长度多态性方法分析维生素D受体TaqI、FokI、ApaI、Bsm I基因多态位点,并比较三组儿童的基因型及等位基因频率情况。结果重症组患儿的血清25(OH)D水平为(52.67±12.22)nmol/L,明显低于轻症组的(65.57±13.54)nmol/L,而轻症组又明显低于对照组的(82.57±15.30)nmol/L,IL-4、IL-5分别为(152.28±22.47)ng/L、(51.83±9.83)ng/L,明显高于轻症组的(130.48±21.35)ng/L、(44.72±8.70)ng/L,而轻症组又明显高于对照组的(77.48±15.26)ng/L、(26.52±7.78)ng/L,差异均有统计学意义(P<0.05);经Hardy-Weinberg平衡定律检测不同组别间VDR基因序列等位基因分布的频率,数据均符合平衡定律(P<0.05);重症组患儿的VDR TaqI(rs731236)基因型TT及等位基因C均高于轻症组和对照组,基因型TC、等位基因T型频率均低于轻症组和对照组,差异均有统计学意义(P<0.05),但三组基因型的CC频率分布比较差异无统计学意义(P>0.05);三组儿童的VDR FokI(rs2228570)基因型频率分布比较差异均无统计学意义(P>0.05),但重症组患儿的等位基因C高于轻症组和对照组,T型频率低于轻症组和对照组,差异均有统计学意义(P<0.05);重症组患儿的VDR ApaI(rs7975232)基因型GG及等位基因G高于轻症组和对照组,基因型GT及等位基因A频率分布低于轻症组和对照组,差异均有统计学意义(P<0.05);重症组患儿的VDR Bsm I(rs1544410)基因型GA、AA及等位基因A均高于轻症组和对照组,基因型GG及等位基因G频率分布低于轻症组和对照组,差异均有统计学意义(P<0.05)。结论RSV感染性毛细支气管炎患儿的血清25(OH)D明显较低,VDR TaqI、FokI与患儿发病具有一定相关性,临床上可通过检测患儿VDR基因多态性状况,进一步分析患儿病情严重程度状况,并及时根据遗传体征状况提供针对性的预防和治疗方案。

布地奈德结合重组人干扰素α1b雾化吸入对RSV毛细支气管炎患儿肺功能指标的影响探讨

目的 探究对呼吸道合胞病毒(RSV)毛细支气管炎患儿应用布地奈德结合重组人干扰素α1b雾化吸入的效果及对其肺功能指标的影响。方法 选取92例RSV毛细支气管炎患儿,采用Excel表格分组法分为实验组与参照组,每组46例。参照组给予基础方案治疗,实验组给予布地奈德结合重组人干扰素α1b雾化吸入治疗。比较两组治疗效果、症状与体征消失时间、肺功能指标[潮气量(TV)、呼气峰流速(PEF)、达峰时间比(TPTEF/TE)及达峰容积比(VPTEF/VE)]及炎性因子[白细胞介素-10(IL-10)及干扰素-γ(INF-γ)]水平。结果 实验组治疗总有效率97.83%高于参照组的86.96%,组间对比差异成立(P<0.05)。实验组症状与体征消失时间中肺部啰音、三凹征、喘息、咳嗽消失时间分别为(4.65±0.88)、(2.96±0.52)、(3.70±1.08)、(5.18±1.30)d,均短于参照组的(5.41±1.13)、(4.20±0.87)、(4.22±0.96)、(2.79±1.24)d,组间对比差异成立(P<0.05)。实验组肺功能指标中TV、PEF、TPTEF/TE及VPTEF/VE分别为(7.51±1.29)ml/kg、(5.73±1.54)L/s、(26.91±7.08)%、(29.84±5.33)%,均高于参照组的(6.35±1.47)ml/kg、(4.02±0.83)L/s、(23.25±6.46)%、(26.91±4.32)%,组间对比差异成立(P<0.05)。实验组炎性因子指标中IL-10及INF-γ水平分别为(28.06±5.37)、(38.25±6.43)ng/L,均高于参照组的(15.64±7.22)、(29.36±5.24)ng/L,组间对比差异成立(P<0.05)。结论 布地奈德结合重组人干扰素α1b雾化吸入治疗RSV毛细支气管炎患儿的效果较好,临床症状与体征消失时间短,肺功能指标及炎性因子水平改善明显,具有重要临床应用价值。

HMGB1对呼吸道合胞病毒毛细支气管炎合并肾脏受累型过敏性紫癜患儿单核细胞免疫功能的影响

目的:探讨高迁移率族蛋白1(HMGB1)对呼吸道合胞病毒(RSV)毛细支气管炎合并肾脏受累型过敏性紫癜(HSP)患儿单核细胞免疫功能的影响。方法:选择初诊为RSV毛细支气管炎合并肾脏受累HSP患儿30例作为观察组,选取同期进行体检的健康足月婴幼儿30名作为对照组,2组婴幼儿入院后采集血浆样本,进行常规血细胞分析和C反应蛋白(CRP)水平检测,并采用ELISA法检测2组婴幼儿血浆中HMGB1的表达水平。采用人重组RSV-A2病毒转染人支气管上皮细胞系16HBE,并收集细胞培养上清检测HMGB1。使用经孔板共培养RSV感染细胞、无感染组的人支气管上皮细胞系16HBE和单核细胞THP1,qRT-PCR法测定细胞总RNA,采用Western blotting检测单核细胞中Toll样受体TLR-4和TLR-7的水平。结果:RSV毛细支气管炎合并肾脏受累HSP患儿外周血较健康对照组较健康对照组中HMGB1的表达水平升高(t=5.84,P<0.05),且外周血单核细胞数量、外周淋巴细胞数量及CRP水平与RSV毛细支气管炎合并肾脏受累HSP患儿外周血中HMGB1表达水平呈正相关关系(r=0.606、0.301、0.394,P<0.05),其中外周血单核细胞数量与外周血中HMGB1表达水平相关性最显著(P<0.05)。经qRT-PCR检测,经病毒转染后的16HBE细胞培养基中HMGB1的表达相较对照组显著增加(t=5.41,P<0.05)。RSV转染的16HBE细胞、感染对照组、HMGB1抑制组分别与单核细胞THP-1进行共培养后,经Western blotting检测单核细胞中TLR-4和TLR-7蛋白的表达水平,结果显示THP-1细胞中TLR-4的表达水平增加(P<0.05),而TLR-7水平无显著变化(P>0.05)。结论:HMGB1的表达水平与儿童RSV毛细支气管炎合并肾脏受累HSP病情的发展有关,HMGB1在单核细胞介导的免疫性炎症中起着重要作用,对掌握儿童RSV毛细支气管炎的发病机制具有重要意义。

干扰素α-2b治疗小儿呼吸道合胞病毒毛细支气管炎的疗效及对患儿血清SP-D、TGF-β及IL-4水平的影响

目的探讨干扰素α-2b在小儿呼吸道合胞病毒(respiratory syncytial virus,RSV)毛细支气管炎患儿中的治疗效果。方法方便选取2021年6月—2023年6月单县妇幼保健院收治的86例RSV毛细支气管炎患儿为研究对象,使用不同治疗方法将其分两组,各43例。对照组采用常规治疗,观察组在对照组基础上添加干扰素α-2b治疗。比较两组临床效果、血清学指标、症状消失时间、治疗安全性。结果观察组治疗总有效率为95.35%(41/43),高于对照组的79.07%(34/43),差异有统计学意义(χ^(2)=5.108,P=0.024)。观察组肺表面活性蛋白D、白介素-4、超敏C反应蛋白、白介素-8及降钙素原均低于对照组,转化生长因子β高于对照组,差异有统计学意义(P均<0.05)。观察组症状消失时间短于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论干扰素α-2b可以改善RSV毛细支气管炎患儿临床症状,促进血清学指标复常,不良反应少。

Polymorphisms in the promoter region of IL10 gene are associated with virus etiology of infant bronchiolitis

Background Bronchiolitis is the most common infection leading to hospitalization in infancy. Interleukin-10 (IL-10) is an anti-inflammatory cytokine, and in our previous study, IL10 gene rs1800896 (-1082A/G) polymorphism was associated with viral etiology of infant bronchiolitis. The objective of this study was to evaluate the associations between IL10 single nucleotide polymorphisms (SNPs) at rs1800890 (-3575A/T), rs1800871 (-819C/T) or rs1800872 (-592C/A) either alone or combined with the SNP at rs1800896 (-1082G/A), and the etiology and severity of infant bronchiolitis. Methods Data on four IL10 SNPs were available from 135 full-term infants, hospitalized for bronchiolitis at age less than 6 months, and from 378 to 400 controls. Viral etiology was studied, and oxygen support, feeding support and the length of stay in hospital were recorded during bronchiolitis hospitalization. Results Infants with rhinovirus bronchiolitis had the IL10 rs1800890 variant AT or TT genotype less often (18.2%) than controls (63.3%, P=0.03), and likewise, had the IL10 rs1800896 variant AG or GG genotype less often (27.3%) than con-trols (65.5%, P=0.009). Twenty-eight infants with bronchiolitis had the variant–variant Grs1800896Trs1800890 haplotype, and none of them had rhinovirus infection. The IL10 rs1800871 or rs1800872 genotypes showed no associations with viruses. No association was found between any genotypes and bronchiolitis severity measures. Conclusion IL10 rs1800890 and rs1800896 polymorphisms differed between infants with rhinovirus bronchiolitis and con-trols, but not between infants with respiratory syncytial virus bronchiolitis and controls.

毛细支气管炎患儿25羟基维生素D、T淋巴细胞亚群水平变化及与FeNO水平的关系

目的分析毛细支气管炎患儿25羟基维生素D[25-(OH)D3]、T淋巴细胞亚群水平变化以及与呼出气一氧化氮(FeNO)水平的关系。方法回顾性选取2019年4月至2021年7月廊坊市人民医院收治的100例毛细支气管炎患儿作为研究对象,依据患儿病情程度,将患儿分为轻度组(n=34)、中度组(n=36)和重度组(n=30),选取同期来廊坊市人民医院体检的32名健康婴幼儿作为对照组。比较4组的研究对象降钙素原、C反应蛋白(CRP)、白细胞计数、中性粒细胞计数、淋巴细胞计数、25-(OH)D3、CD3^(+)/CD4^(+)、CD3^(+)/CD56^(+)、CD3^(+)/CD8^(+)、FeNO水平。采用Pearson相关性分析FeNO与25-(OH)D3、CD3^(+)/CD4^(+)、CD3^(+)/CD8^(+)、CD3^(+)/CD56^(+)、降钙素原、淋巴细胞计数的相关性。结果不同病情毛细支气管炎患儿及对照组婴幼儿CRP、白细胞计数、中性粒细胞计数比较,差异均无统计学意义(P>0.05);重度组的降钙素原水平显著高于中度组、轻度组及对照组,差异均有统计学意义(P<0.05);重度组的淋巴细胞计数、25-(OH)D3、CD3^(+)/CD8^(+)比值、CD3^(+)/CD56^(+)比值均低于轻度组、对照组,差异均有统计学意义(P<0.05),但与中度组比较,差异无统计学意义(P>0.05);重度组、中度组的CD3^(+)/CD4^(+)水平均高于对照组、轻度组,差异均有统计学意义(P<0.05),而对照组与轻度组比较,中度组与重度组比较,差异均无统计学意义(P>0.05);重度组的FeNO水平高于中度组、轻度组、对照组,差异均有统计学意义(P<0.05),重度组与中度组比较,差异无统计学意义(P>0.05)。FeNO与25-(OH)D3、CD3^(+)/CD8^(+)、淋巴细胞计数呈负相关(P<0.05),FeNO与CD3^(+)/CD4^(+)、降钙素原呈正相关(P<0.05)。结论毛细支气管炎患儿CD3^(+)/CD4^(+)、FeNO升高,25-(OH)D3、CD3^(+)/CD8^(+)、CD3^(+)/CD56^(+)降低,且变化幅度与病情严重程度相关。FeNO与25-(OH)D3、CD3^(+)/CD8^(+)、淋巴细胞计数呈负相关,与CD3^(+)/CD4^(+)、降钙素原呈正相关。

白藜芦醇抑制TLR4/NF-κB通路对毛细支气管炎小鼠的保护作用

目的研究白藜芦醇通过抑制T样受体4/核因子-κB(TLR4/NF-κB)通路对呼吸道合胞病毒(RSV)毛细支气管炎小鼠的保护作用。方法选取30只小鼠随机分为对照组、RSV组、给药组,建立RSV毛细支气管炎小鼠模型,检测小鼠肺组织中TLR4、NF-κB的变化;利用肺组织HE染色、ELISA法检测白藜芦醇给药前后气道炎症病变、IL-6、TNF-α因子水平,Western Blot法及实时定量PCR法检测TLR4、NF-κB蛋白及基因表达等相关变化。结果与对照组相比,RSV组小鼠组肺组织中TLR4、NF-κB水平升高,肺组织切片HE染色显示气道炎症细胞浸润加剧,ELISA检测炎性因子IL-6、TNF-α升高;而给药组处理后,肺组织TLR4、NF-κB的表达下调,病理改变减轻,炎性因子IL-6、TNF-α下降。结论白藜芦醇可通过抑制TLR4/NF-κB通路抑制炎性因子的释放,从而减轻毛细支气管炎小鼠的气道炎症反应。

Clinical epidemiology and disease burden of bronchiolitis in hospitalized children in China:a national cross-sectional study

Background Bronchiolitis is a common acute lower respiratory tract infection(ALRTI)and the most frequent cause of hospitalization of infants and young children with ALRTI.Respiratory syncytial virus is the main pathogen that leads to severe bronchiolitis.The disease burden is relatively high.To date,few descriptions of the clinical epidemiology and disease burden of children hospitalized for bronchiolitis are available.This study reports the general clinical epidemiological characteristics and disease burden of bronchiolitis in hospitalized children in China.Methods This study included the face sheet of discharge medical records collected from 27 tertiary children’s hospitals from January 2016 to December 2020 that were aggregated into the FUTang Update medical REcords(FUTURE)database.The sociodemographic variables,length of stay(LOS)and disease burden of children with bronchiolitis were analyzed and compared using appropriate statistical tests.Results In total,42,928 children aged 0–3 years were hospitalized due to bronchiolitis from January 2016 to December 2020,accounting for 1.5%of the total number of hospitalized children of the same age in the database during the period and 5.31%of the hospitalizations for ALRTI.The male to female ratio was 2.01:1.Meanwhile,more boys than girls were observed in different regions,age groups,years,and residences.The 1–2 year age group had the greatest number of hospitalizations for bronchiolitis,while the 29 days–6 months group had the largest proportion of the total inpatients and inpatients with ALRTI in the same age group.In terms of region,the hospitalization rate of bronchiolitis was the highest in East China.Overall,the number of hospitalizations from 2017 to 2020 showed a decreasing trend from that in 2016.Seasonally,the peak hospitalizations for bronchiolitis occurred in winter.Hospitalization rates in North China in autumn and winter were higher than those in South China,while hospitalization rates in South China were higher in spring and summer.Approximately,half of the patients with bronchiolitis had no complications.Among the complications,myocardial injury,abnormal liver function and diarrhea were more common.The median LOS was 6 days[interquartile range(IQR)=5–8],and the median hospitalization cost was 758 United States dollars(IQR=601.96–1029.53).Conclusions Bronchiolitis is a common respiratory disease in infants and young children in China,and it accounts for a higher proportion of both total hospitalizations and hospitalizations due to ALRTI in children.Among them,children aged 29 days–2 years are the main hospitalized population,and the hospitalization rate of boys is significantly higher than that of girls.The peak season for bronchiolitis is winter.Bronchiolitis causes few complications and has a low mortality rate,but the burden of this disease is heavy.

外周血miR-126在呼吸道合胞病毒感染毛细支气管炎进展为支气管哮喘中的意义

目的探讨外周血miR-126在呼吸道合胞病毒(RSV)感染毛细支气管炎患儿进展为支气管哮喘中的意义。方法收集郑州大学附属儿童医院2018年6月至2019年6月收治的RSV毛细支气管炎患儿126例,其中男77例、女49例。采用RT-PCR法检测miR-126相对表达水平,根据2年随访结果将其分为非哮喘组(94例)与哮喘组(32例),受试者工作特征曲线(ROC)分析miR-126在RSV毛细支气管炎进展为哮喘中的预后价值,logistic回归分析miR-126是否是RSV毛细支气管炎进展为哮喘的影响因素。采用χ^(2)检验、独立样本t检验。结果哮喘组患儿外周血miR-126表达水平显著高于非哮喘组[(8.43±5.14)比(5.03±3.88)](P<0.001);ROC分析显示miR-126预测RSV毛细支气管炎进展为哮喘的曲线下面积为0.691,灵敏度为88.30%,特异度为59.38%;miR-126是RSV毛细支气管炎进展为支气管哮喘的独立危险因素[OR=9.878(3.752~26.007),P<0.001]。结论外周血中miR-126对于RSV毛细支气管炎患儿进展为支气管哮喘具有一定预测价值。

孟鲁司特钠对呼吸道合胞病毒毛细支气管炎患儿的临床疗效及对免疫功能、预后复发哮喘的影响

目的探究孟鲁司特钠对呼吸道合胞病毒(RSV)毛细支气管炎患儿的临床疗效及对免疫功能、预后复发哮喘的影响。方法回顾性选取2019年8月至2021年8月在广西医科大学附属武鸣医院接受治疗的RSV毛细支气管炎患儿110例,根据其治疗方式进行分组。其中在常规基础上联合孟鲁司特钠治疗的55例患儿计为观察组,采用常规治疗的55例患儿计为对照组。评估两组患儿的治疗疗效,比较两组患儿的治疗前以及治疗后1周血清嗜酸粒细胞阳离子蛋白(ECP)、半胱氨酰白三烯(CysLTs)、尿白三烯E4(LTE4)、白细胞介素-8(IL-8)水平,观察两组患儿糖皮质激素、β-受体激动剂应用情况,以及咳嗽、哮喘消失时间、住院时间。观察两组患儿治疗后不良反应的发生情况和哮喘复发情况。结果观察组总有效率为96.36%,高于对照组的85.45%,差异有统计学意义(P<0.05)。治疗后,两组血清ECP、CysLTs、LTE4、IL-8水平均较治疗前下降,观察组以上指标水平为(33.07±5.41)μg/L、(16.62±5.17)ng/L、(68.36±10.22)kU/L、(41.05±8.63)μg/mL,均低于对照组[(40.24±9.38)μg/L、(19.58±3.42)ng/L、(76.04±1.55)kU/L、(48.24±12.05)μg/mL],差异均有统计学意义(P<0.05)。两组患儿的糖皮质激素使用百分比比较,差异无统计学意义(P>0.05),但观察组患儿应用β-受体激动剂占比为25.45%,较对照组(45.45%)高,且咳嗽/哮喘消失时间和住院时间为(6.05±1.53)、(5.04±1.19)、(7.04±2.18)d,短于对照组[(8.24±0.68)、(6.60±1.88)、(8.21±1.95)d],差异均有统计学意义(P<0.05)。观察组不良反应总发生率为27.27%,对照组为16.36%,差异无统计学意义(P>0.05);观察组随访6个月内再次哮喘发生率分别为14.55%,较对照组(30.91%)低,差异有统计学意义(P<0.05)。结论孟鲁司特钠可提高RSV毛细支气管炎患儿临床治疗疗效,增强其免疫功能、缓解炎症,降低预后复发哮喘概率。

基因重组干扰素γ与孟鲁司特钠联合治疗呼吸道合胞病毒感染引起毛细支气管炎的效果及对患儿炎症指标的影响

目的探讨基因重组干扰素γ与孟鲁司特钠联合治疗呼吸道合胞病毒(RSV)感染引起毛细支气管炎的效果及对患儿炎症指标的影响。方法选取2019年1月至2021年11月本院收治的130例RSV感染引起的毛细支气管炎患儿作为研究对象,随机分为对照组与观察组,各65例。对照组予以孟鲁司特钠治疗,观察组在对照组基础上联合基因重组干扰素γ治疗,比较两组临床疗效、围手术期指标、炎症指标[肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6、IL-8]及肺功能指标[用力肺活量(FVC)、第1秒用力呼气容积(FEV_(1))、FEV_(1)/FVC]。结果观察组治疗总有效率为95.38%,高于对照组的81.54%,差异有统计学意义(P<0.05)。观察组呼吸困难消失时间、咳嗽消失时间、喘憋消失时间、住院时间均短于对照组,差异有统计学意义(P<0.05)。治疗前,两组TNF-α、IL-6、IL-8水平比较差异无统计学意义;治疗后,两组TNF-α、IL-6、IL-8水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗前,两组FVC、FEV_(1)、FEV_(1)/FVC比较差异无统计学意义;治疗后,两组FVC、FEV_(1)、FEV_(1)/FVC均高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05)。结论基因重组干扰素γ与孟鲁司特钠联合治疗RSV感染引起的毛细支气管炎效果显著,可改善患儿临床症状,降低炎症因子水平,值得临床推广应用。

定喘汤治疗呼吸道合胞病毒感染的毛细支气管炎的代谢组学研究

目的基于代谢组学探讨定喘汤治疗呼吸道合胞病毒(RSV)感染毛细支气管炎的疗效。方法选取2016年9月至2017年2月于我院接受治疗的30例RSV感染的毛细支气管炎患儿为研究对象(毛细组),另选同期于我院体检的38例健康儿童为对照组。采用LC-MS/MS行代谢组学检测,对比2组儿童的代谢产物,毛细组患儿均给予定喘汤治疗,通过代谢组学检测探讨定喘汤发挥疗效的机制。结果与对照组相比,毛细组代谢改变差异明显的代谢产物为3个溶血磷脂酰胆碱(LPC)(LPC 18∶2 sn-1、LPC 18∶0 sn-1和LPC 18∶0 sn-2),苯丙氨酸(Phe),3个磷脂酰胆碱(PC)(PC 34∶3、PC 34∶2、PC 34∶1);毛细组接受定喘汤治疗前后代谢改变差异明显的代谢产物主要为LPC 18∶0 sn-1、LPC 18∶0 sn-2、LPC 16∶0 sn-1,Phe,PC 34∶2,鞘磷脂(SM)34∶1以及去甲-戊二酰胺;治疗后代谢产物变化最明显的为LPC 18∶0 sn-1和LPC 18∶0 sn-2。结论利用代谢组学可区分RSV感染致毛细支气管炎患儿在接受定喘汤治疗前后的不同代谢模式,其中脂代谢产物差异最明显,可认为是定喘汤发挥治疗作用的重要机制。

重组干扰素α-2b治疗小儿呼吸道合胞病毒毛细支气管炎对肺表面活性蛋白D和转化生长因子-β的影响

目的探讨重组干扰素α-2b治疗小儿呼吸道合胞病毒毛细支气管炎对肺表面活性蛋白D(SP-D)、转化生长因子-β(TGF-β)的影响。方法选取2019年3月至2020年10月于本院儿科就诊的174例呼吸道合胞病毒所致的毛细支气管炎患儿作为研究对象,按照随机数字表法分为对照组与观察组,每组87例。对照组给予布地奈德混悬液联合孟鲁司特钠治疗,观察组在对照组基础上增加重组人干扰素α-2b治疗,比较两组临床疗效、临床症状消失时间及住院时间、实验室指标(SP-D、TGF-β)及不良反应发生率。结果观察组治疗总有效率为96.55%,高于对照组的88.51%,差异有统计学意义(P<0.05)。观察组喘憋消失时间、肺部湿啰音消失时间、咳嗽消失时间及住院时间均短于对照组,差异有统计学意义(P<0.05)。治疗前,两组SP-D、TGF-β水平比较差异无统计学意义;治疗7 d后,两组SP-D水平低于治疗前,TGF-β水平高于治疗前,且观察组SP-D水平低于对照组,TGF-β水平高于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较差异无统计学意义。结论重组干扰素α-2b治疗小儿呼吸道合胞病毒致毛细支气管炎疗效显著,有助于加快缓解患儿临床症状,降低SP-D水平,提高TGF-β水平,且安全性较高,值得临床推广应用。

呼吸道合胞病毒毛细支气管炎与支气管哮喘的相关性研究

目的探讨呼吸道合胞病毒(RSV)毛细支气管炎(毛支)与支气管哮喘两者发病机制的相关性。方法采用ELISA法检测31例RSV毛支患儿、25例支气管哮喘患儿、27例非RSV肺炎患儿和24例健康儿童外周血IFN-γ、IL-4、IL-10、TGF-β、IL-17水平,并进行比较分析。结果 RSV毛支患儿和哮喘患儿的IL-10、TGF-β水平显著低于非RSV肺炎患儿和健康对照儿童,而IL-4、IL-17水平则显著高于非RSV肺炎患儿和健康对照儿童(P均<0.05)。RSV毛支患儿和哮喘患儿的IFN-γ/IL-4、IL-10/IL-17比例显著低于非RSV肺炎患儿和健康对照儿童(P均<0.05),哮喘患儿的TGF-β/IL-17显著低于非RSV肺炎患儿与健康对照儿童(P均<0.05)。RSV毛支患儿与哮喘患儿之间、非RSV肺炎患儿与健康对照儿童之间IFN-γ、IL-4、IL-10、TGF-β、IL-17水平及其比值IFN-γ/IL-4、IL-10/IL-17、TGF-β/IL-17的差异均无统计学意义(P均>0.05)。结论 RSV毛支患儿与哮喘患儿存在相同的外周血细胞因子IFN-γ、IL-4、IL-10、TGF-β、IL-17水平的改变,这可能是其共同的发病机制之一。

孟鲁司特治疗对婴幼儿呼吸道合胞病毒毛细支气管炎气管炎症和再次喘息的影响

目的探讨孟鲁司特治疗呼吸道合胞病毒(RSV)感染的毛细支气管炎12周后对气管炎症和再次喘息的影响。方法纳入2010年12月至2011年12月四川省人民医院收治的60例6～24个月的RSV毛细支气管炎患儿,按入院先后顺序随机分为孟鲁司特组(30例)和常规治疗组(30例)。常规治疗组给予布地奈德雾化吸入等综合治疗,孟鲁司特组在综合治疗的基础上加用孟鲁司特维持治疗(4 mg,每晚1次口服,治疗12周)。同期门诊体检健康儿童30例为正常对照组,除外特应症及近期呼吸道感染者。治疗前和12周后检测血清中半胱氨酰白三烯(CysLTs)、总IgE(T-IgE)、嗜酸粒细胞阳离子蛋白(ECP)、呼出气一氧化氮(FeNO)水平。在门诊及电话随访12个月内统计两组再次喘息患儿例数。结果两组RSV毛细支气管炎患儿治疗前CysLTs、ECP和FeNO水平均显著高于正常对照组(P<0.05),治疗后CysLTs和FeNO水平均较治疗前显著降低(P<0.05)。常规治疗组ECP水平治疗前后无明显变化(P>0.05),孟鲁司特组治疗后ECP水平较治疗前显著降低(P>0.05)。孟鲁司特组治疗后CysLTs和FeNO水平显著降低,并显著低于常规治疗组治疗后水平(P<0.05)。孟鲁司特组在12个月内累计再次喘息患儿例数显著低于常规治疗组(P<0.028)。结论毛细支气管炎急性期治疗后予孟鲁司特维持治疗可以显著抑制气道炎症,减少喘息复发的风险。